Let me tell you what scares the shit out of me.  Ready for this?  It’s watching what happens to people in nursing homes.  In the 1980s, part of my job was to transport the elderly to nursing homes.  My partner and I would arrive at their home with a stretcher, navigate around the furniture and stop at the patient’s bedroom door.  I would knock lightly until I heard the patient call us in.  It was always the same scene.  The nightstand had six bottles of medication for heart problems, high blood pressure, acid reflux, diabetes and dementia—to name a few ailments.  I would walk in and say, “How are you?  We’re here to give you a ride.”  My partner and I would slide our hands under the patient’s back, hips and legs to slowly transfer him or her from the bed onto our stretcher. 

The patients were anorexic; their thin arms and legs were skin over bone—no muscle.  I remember being very careful, thinking their bones could just snap with any stressful movement.  I would talk to the patient and explain every step we were taking.  Imagine two strangers showing up in your bedroom while you’re in your pajamas—not a comfortable situation—but it was funny, many times the folks were glad to see us, because they had someone to talk to.  It was then I learned that aging can be lonely.  When trying to communicate with some of these folks we’d get a dead, five-mile stare; they looked right through us. They had lost all facial expression, like overmedicated cattle.  Antidepressant administration numbs any feeling of reality along with those beautiful memories that bring smiles after 70 years of dancing on this blue marble.  It was just heartbreaking to see.

From the Mouths of the Aged

Through the years, I’ve often thought of the older patients I transported as a paramedic.  Instead of Tuesdays with Morrie, it was ten minutes with Russ.  These beautiful, frail people spoke the truth—many times while holding my hand.  One woman said during our conversation that her husband was gone, and her kids lived across the country and didn’t call her.  She looked at me and said, “Son I’m ready to go.  There’s nothing here for me anymore.”  I can still see that woman’s face when I close my eyes.  She was a gift that stayed with me and shaped my behavior the rest of my life.  You want a reason to exercise and eat right?  Well, there it is in living color! 

I took patients to both nursing homes and assisted living centers from 1976 to 1996 and watched how these facilities operated; nothing has changed since.  They were lined up in rows of 10 and 4 rows deep to watch The Price is Right.  Just shoot me!  After years of seeing this bad dream repeat itself each shift and then dealing with my own family, helping people age gracefully has become my mission—by any means necessary.

The Key to Youth

At age 87, my mother walked five miles a day, was on hormonal replacement and was still cognitively in the game.  Therefore, I thought that arranging for her to make friends and play games with her contemporaries at a senior center would be enjoyable for her.  Well, that idea crashed and burned. 

I pulled up to her house before 8:00 am and she was waiting out front in a blue dress, black sandals and sterling silver bracelets.  My mother would dress up to go to the store; she loved clothes.  She used to tell me that the color of your clothes speaks to how you feel.

I was greeted with, “Christ, where were ya?  It’s ninety degrees out here!  I’ve been waiting!”  She was smiling and shaking her head, so I figured she was looking forward to the new experience.  I dropped her off at the center.

I drive back to pick her up at 3:00 pm, expecting that she would have had a blast with a full day of activities and lunch.  I was going to park and walk inside to find her when I saw her standing outside looking down the street for my car.  I pulled up and opened the side door.

“Hey, mom, how ya doing?  Did you have a nice time?”  She glared at me, and I knew she was pissed.  Growing up, I caused this facial expression many times.  Oh shit, here we go!

“I’m never going back there again!  Take me home,” she said in a huff.

“Mom, what happened?”

My mom was 100% Irish: she never met a stranger and would drop F-bombs in church.  In the blink of an eye, her no-bullshit Jersey DNA flared.

“Oh Christ!  What happened?  All those people could talk about is how sick they are!  I heard about every illness from vomiting to the shits.  No way I’m going back, it’s depressing!”

My mom always looked at the world though a young person’s lens; this kept her healthy.

The drive home was quiet, and I was ruminating.  My mother like being around young people, always had.  What was I thinking?  Well, I checked that fucking box.  She would laugh out loud while caring for my sister’s kids and would have deep conversations with the girlfriends I brought home over the years.  We would have big dinners and invite the neighbors.  I can still hear her distinctive laugh.

As humans we have a need for affiliation; our community can keep us healthy.  Evolutionary biologists say we all need to be members of a healthy tribe and I knew thousands of Americans were going through exactly what I did, trying like hell to make the last few years remaining to their elder loved ones as peaceful and stress free as humanly possible.

Sarcopenia – An Important, But Ignored Disease State

Soon, you be hearing the word, “sarcopenia,” more and more.

Sarcopenia is muscle wasting.  It is of critical interest to geriatricians, nutritionists, gerontologists, epidemiologists, biologists, physical therapists and all other professionals who provide care to the elderly.  Without exercise and eating right, muscle wasting can begin in your thirties. Think about it: if you’ve ever had a cast on a body part, you lose an incredible amount of muscle in six to eight weeks.  Chronic illness and obesity as well as nutritional and hormonal deficiencies contribute as well.  Sarcopenia is one of the most important contributing factors of disability in older folks. 

The US has about 28,000 nursing homes and 18,000 assisted living centers.  Ninety percent of the men and women at these facilities have sarcopenia and there is no treatment available.  The US has one of the most advanced medical systems in the world, but when it comes to sarcopenia, all it can come up with as a treatment is “exercise.”  Recent clinical trials on sarcopenia therapies such as physical exercise, nutraceutical and pharmaceutical interventions have revealed that exercise is the only effective strategy shown to alleviate sarcopenia.

Don’t believe this for a second.

As always, Big Pharma is looking for the next billion-dollar drug for sarcopenia.  They will never find it.  Genetic editing using CRISPR/Cas9 technology is an option but that’s years away.  There are interventions we can apply right NOW.  As you may know if you’ve followed my blog or YouTube channel for a while, I’ve trained hundreds of physicians at anti-aging centers around the US and witnessed with my own eyes the men and women over 60 living their best lives after retirement.  They had the energy and strength to go on trips and stay active.  How?  Spoiler alert:  Using low-dose testosterone, estrogen, progesterone and human growth hormone can be lifesaving!  Let’s go a little deeper.

What Causes Sarcopenia?

The Global Leadership Initiative on Malnutrition has proposed muscle mass as one of the diagnostic criteria for malnutrition.  Low muscle mass with normal muscle function shows that malnutrition is present. 

After age fifty, our intestinal tract doesn’t pull vitamins, minerals, amino acids and fats out of food as well, so this is where the muscle wasting starts.  The food at nursing homes is high in carbohydrates and low in protein, which spikes blood glucose and insulin and causes an inflammatory response in the body.  They lack nutrition from protein and fatty acids which is needed at the cellular level for organ functionality.  If older people don’t get enough amino acids from protein, their bodies will mine it out of muscle, bone, heart and brain. 

When an elderly person needs to lose fat, not muscle, it’s never done properly.  Physicians, nurses, dieticians and physical therapists focus on the number on the scale, which does not tell us the muscle to fat ratio.  Muscle is critical for the elderly to maintain.  DEXA scans can tell us the ration of bodyfat to muscle. 

Skeletal muscle is the largest function tissue system in the human body.  Muscle mass is critical for the function of our immune system, brain and heart.  I’ll bet you never knew muscle was so important!  Not the big, bulging Arnold Schwarzenegger muscle…that’s just for posing.  We need the muscle of performance that’s dense with mitochondria, those microscopic powerhouses of the cell.  They create ATP (i.e., energy) from the carbohydrates, protein and fat we eat.  We want lean, functional muscle, like a swimmer’s build.  As we age, we lose muscle mass.  If you lose your mobility, you lose everything—muscle is arguably your best indicator of longevity!  But if you ask the AMA, Big Pharma or your physician what we can do to slow sarcopenia in people over fifty, you’ll hear crickets.

The Importance of Functional Muscle

From an endurance athlete perspective, one example of the value of functional muscle I’ll never forget was when two of my triathlete friends signed up for an endurance race.  It was an obstacle course over five miles.  They needed a third person and one of our friends, a bodybuilder, wanted to join the team.  With all that muscle he barely made it through the course.  During one part, they had to run a half mile and carry two plastic gallon water jugs.  The bodybuilder was so out of breath, he was bent over, hands on his knees.  The two triathletes had to take the bodybuilder’s water from him and help him cross the finish line.  Big, bulging muscle looks great, but it’s not very functional.  Ya catch my drift?

As we age, we want to focus on strength and functional muscle.  Think about your heart:  it’s as big as your fist and beats 100,000 times a day, circulating 2,000 gallons of blood.  The first heartbeat starts at six weeks of gestation, and it can do this for 90 years—that just blows your hair back when you think about it, right?  That’s a functional muscle if there ever was one.  The best engineers at Mercedes Benz can’t build a pump that efficient.

Out of This World: NASA’s Misguided Approach to Sarcopenia

I was reading the story of Scott Kelly, the first astronaut to spend a year in the International Space Station.  Scott experienced muscle wasting, heart atrophy (the heart is, after all, a muscle) and inflammation in his joints, and was finding it difficult to walk the first few week back on Earth.  His diet and exercise routine were also tracked.  Vitamin D was one of the only supplements provided.  NASA focused on bone loss when it should have been concentrating on muscle wasting.  They need to develop a diet, nutrition and hormonal replacement program which would keep bones AND muscles strong.  One study here speaks to the current research underway:  Space Flight Diet-Induced Deficiency and Response to Gravity-Free Resistive Exercise  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468946/

Osteosarcopenia is the loss of both muscle and bone.  Strengthening muscles with resistance exercise prevents muscle atrophy and helps bones stay strong.  Now add on some testosterone and human growth hormone, which work in synergy with resistance exercise.  I trained physicians in these therapies while setting up anti-aging centers in 2004.

Think about it, if Elon Musk wants to go to Mars, it will take about nine months to get there, several months to complete their mission and nine months back.  Preserving muscle will play a critical role in astronaut performance but it’s not discussed.  We can get hundreds of studies on sarcopenia from AIDS patients, burn patients and cancer patients.  This is where we gleaned much of our research at the cellular level and built on those studies.  (You would think NASA would do the same.)

The Failure of Conventional Medicine

My memories of taking people to nursing homes and seeing them lay in their own urine and feces for hours will never leave me.  Thinking about my aging mother and father going through this made me want to vomit.  I wanted to change our medical system, where the wheels move slow:  200 years of tradition unaffected by progress.

We are going to need approximately 30,000 geriatricians by the year 2030.  This specialty field of medicine for the elderly is dying so it’s up to us to secure the best treatments for our family members.  Many people are building additions to their existing homes to care for family members so they can oversee their treatment—as they should. 

I’ve worked with multimillionaires, professional athletes and Hollywood celebrities and guess what?  They’re in the same boat.  Imagine, with all their connections and money, they still can’t get access to the best treatments—mostly because they don’t even know what they are!  My team has consulted with families and physicians all over the US and we want to help educate as our population ages.

How can we navigate the broken medical system and get the treatment we need?  This is the reason I started Scala Precision Health.  The mission was always to educate people to make smart choices.  Like a finance expert helps invest your money, we focus on aging and quality of life—so you can actually use the money you worked so hard for to have fun later in life!

In 2005, I had to interview six physicians to get my father with diabetes and mother with early dementia on nutritional and hormonal support.  Their quality of life improved in weeks.  This is what I’m sharing with people now.

First, Do No Harm

It’s no secret.  Conventional medicine is broken. People get seven minutes with their GP, who is worthless when it comes to improving or extending quality of life.  At best, they hand out multiple medications that have a list of life-altering side effects and make the last few years of life the Bataan Death March.  Who wants to live that way?  I sure don’t, and I know you don’t either.

I can’t tell you how many times I’ve handed a doctor a folder with ten studies relevant to a patient’s condition.  When I hand over the studies, they look at me and say, “Is this Dr. Google at work?” 

I always smile and lean in close.

“I know you have no training in nutritional or hormonal replacement so just say thank you and help your fucking patient.  Just do your job.”

I remember when my father was working to develop a medical maintenance program for employees, he theorized that in the third year of medical school, they pumped arrogance up the ass of each med student.

How to Avoid Sarcopenia in Your Golden Years

As Director of Research for Signature Pharmacy in 2004, it was part of my job to educate physicians who were using nutritional and hormonal replacement at anti-aging centers around the US.  

I traveled to anti-aging centers in Chicago, Dallas and Boca Raton while working closely with a facility in Beverly Hills.  On any given day there would be over 50 physicians calling my cell phone.  Our pharmacy was the number-one distributor in the US for bioidentical hormones and Human Growth Hormone (HGH).

The same kind of people I saw in nursing homes in the early 80s were living with an amazing quality of life at these anti-aging centers.  This is the future of medicine:  people will tell their physicians what they need and take charge of their own health.  It’s happening all over the world right now and it’s just fucking glorious to witness after my 40 years in medicine.

The most common cause of sarcopenia is the natural aging process and low levels of hormones.  Excess cortisol and mitochondrial dysfunction also occur at the beginning of many disease processes.  My team has reversed this process in many people.  You can hear their stories at no charge on the Russ Scala YouTube channel, which is my way of giving back while keeping myself in the battle.  At 65 years old, I’m still extremely passionate and curious about human metabolism.

You gradually begin losing muscle mass and strength sometime in your 30s or 40s. This process picks up between the ages of 65 and 80.  Rates vary, but you may lose as much as 8% of your muscle mass each year.

What’s critical is to maintain muscle mass, physical performance and muscle strength.  You do this by starting hormonal replacement in your forties.  Think about this; it’s not rocket science, it’s biology.  In the human metabolism there are three different estrogens, progesterone, testosterone, thyroid hormones and cortisol.  Get these levels tested and correct the deficiencies.  We also test the microbiome, IGF-1 levels, vitamins, minerals and amino acids.

Not only does hormonal replacement help maintain the heart and brain but it slows sarcopenia.  If you want to stay healthy, keep your muscle, but not bodybuilder’s muscle, which speeds the aging process.  See my interview with Dorian Yates, six-time Mr. Olympia on what’s killing bodybuilders and you’ll see what I mean.  Just aim to be lean and strong.

I’ll leave you with this thought.  An old African proverb maintains, “When an elder dies, a library burns to the ground.”

So true!