How Not to Get Old - Part III: The Musculoskeletal System

When discussing the musculoskeletal system vs. aging, there are I feel 3 primary areas to examine:

1. Osteopenia – age-related loss of bone mineral density AKA ‘osteoporosis’
2. Myopenia – age-related loss of muscle tissue mass as well as fatty infiltration
3. Glycation – crosslinking of connective tissue leading to joint stiffness and tissue inelasticity

We will now examine each area in some detail but please remember that this is not medical advice nor instruction, just one persons informed opinion. Do NOT attempt to replicate any of the ideas or concepts outlined in this article.

1. Osteopenia

Bone mineral density (BMD) peaks at around the age of 17-20 years of age and that we all experience a steady, though varied rate of decline from then on. In other words, your bones are at their most dense (though not necessarily ‘strongest’) in your late teens. Then as you get older, depending on the amount of physical loading you subject your bones to, they will become less and less dense, until at some point they may become ‘critically’ weak and prone to easy fracture.

…Or at least this is what I was told at university whilst studying chiropractic medicine. We were also taught that there is essentially nothing one can do to reverse the decline or actually increase BMD beyond this pre-adulthood peak.

…And let me tell you that I think ‘medicine’ needs a rethink in this area. Let me show you why I believe this:

Bone is actually quite a metabolically active tissue with a reasonable rate of turnover. Essentially we have two types of cells within the bone matrix that are relevant to this discussion. The ones that break down minerals in bone are called osteoCLASTS and the ones that increase or deposit minerals in bone are called osteoBLASTS. You can see that a net change (either up or down) in BMD results when there is a mismatch between osteoblastic and osteoclastic activity.

In other words, if the cells that ‘eat’ bone minerals are more active than the cells that deposit bone minerals, there will be a net LOSS in bone mineral density over time.

Once our hormones decide that we are no longer of use to the human race, reproductively speaking (menopause and andropause), the reduction of BMD increases pace dramatically, due to a dramatic reduction in osteoBLAST activity. This is why post-menopausal females and post-andropausal (andropause being the male equivalent of the menopause, i.e. a drastic drop in sex hormone production) men are most at risk of critical loss in BMD, leading to ridiculously easy (and often devastating) fractures.

How do we prevent osteopenia?

Physical activity, especially heavy or shock/impact loading has been shown to lead to greater bone mineral density along the lines of the applied force, load or shock. This is called ‘Wolfes law’ and YOU should google it and see what you think.

However as much as I would love the solution to osteopenia to be as simple as increasing the amount of impact-based exercise, it simply cannot be the case, because our hormones are still going to work against us, inexorably reducing the overall levels of minerals in our skeleton. Exercise might strengthen (or more accurately, delay the onset of weakness) of a few localised areas of our skeleton, but we cannot prevent the overall osteopenia that our hormones decree as inevitable.

… And here is where I suspect that modern medicine has missed a trick… or two. You see modern medicine tends to focus on two areas. Firstly is provides the osteopenic/osteoporitic patient with supplemental calcium and secondly it may provide bisphosphonates (‘fosamax’) to ‘normalise the rate of bone mineral turnover’.  Thirdly (and this is one thing that I definitely agree with), supplemental vitamin D3 may be prescribed and if it is not prescribed, then you should be buying it yourself. D3 is (in conjunction with sunlight) fundamental in assisting the formation and maintenance of correct bone mineral density.

BUT, here is where they (your medical experts) are (in my humble opinion) wrong: firstly, without the correct hormonal signal, all the supplemental calcium in the world will just be excreted, unused.

Secondly, bisphosphonates only inhibit the action of osteoCLASTS, ie it slows the rate of bone mineral resorbtion. It does nothing to promote the action of osteoblasts, i.e. does nothing to directly INCREASE the amount of bone  mineral deposition.

So you can see that all modern medicine can (may) achieve is a slowing down of the rate of decay. And since most patients only become patients once they are already at a stage where their skeletons are significantly degraded (in terms of BMD), we can expect them to never actually improve.

And yet there is a fairly clear solution, that is (to my mind) justifiable on a risk : reward basis. Let me elaborate…

I have mentioned hormonal signals and there is a relatively benign hormone that is solely responsible for stimulating osteoBLAST activity, i.e. increasing the rate at which bone mineral is deposited. It is called growth hormone (GH). Yes it may (in some folks – IF misused) cause a degree of insulin resistance, which might lead (in the long term) to type II diabetes. However, with exercise and appropriate dietary restrictions and/or the use of a very common prescription medication called metformin (for those who simply won’t or cannot modifiy their diet) type II diabetes can almost certainly be avoided.

In part II of this series, you saw me mention GHRP, for its cardio and angio-protective and epithelial rejuvenating properties. GHRP is a peptide (a few amino acids chained together in a specific format) that is injected into the subcutaneous skin around the abdomen. It then travels to the pituitary gland and elicits a release of your own, endogenous growth hormone. This is ‘real’ growth hormone, not something manufactured in a biotech lab. As such it contains all 5 ‘isoforms’ (different types or variants) of your own GH. Each isoform has its own part to play within your body, making GHRP a much more ‘intelligent’ solution than pharmaceutical growth hormone In my opinion.

So the GHRP takes care of the bone mineral density, but does nothing for the collagen framework upon which the bone mineral must be deposited to create ‘bone’.

You can think of the bone mineral as the bricks and the collagen as the mortar which binds the bricks together to give overall shape and form to the structure.

Where do we get this collagen from? Well technically we need 2 things: sex hormones, and vitamin C. Vitamin C can be purchased freely and easily, but sex hormones are another matter entirely, and leads me neatly onto the next section (Myopenia), but first let le summarise:

Osteopenia:

1. Cannot be overcome solely through exercise and healthy living.
2. Vitamin D3 is a very good supplement for healthy bones. It is an intermediate level between calcium and hormones if you will.
3. Supplemental calcium will do very little without the correct hormonal climate.
4. Bisphosphonates only slow down the rate of bone mineral destruction.
5. To actually increase the rate of bone mineral creation we need growth hormone, preferably from our own pituitary, via use of GHRPs
6. The collagen matrix underlying bone minerals is reliant upon decent sex hormone levels and also vitamin C.

2. Myopenia

If anyone ever tells you that ‘muscle turns to fat as you get older, so don’t bother to develop your muscles’, then they should be listened to… and then studiously ignored!

Muscle does not turn into fat in the same way that fat does not turn into muscle, nor does your eyeball turn into a testicle. They are different types of tissue and one type of tissue does not morph into another type of tissue.

However as we age, our muscles do become infiltrated with adipose (fat) tissue, becoming softer and less dense. Also, as we age, due to declining levels of testosterone and growth hormone, we lose contractile proteins from our skeletal muscle, resulting in weaker muscles.

I’m sure you have seen at least one old man, made so feeble by age (and inactivity) that he cannot get out of a chair or wipe his own backside. This sort of desperate situation seems even more upsetting to me personally because quite frankly it could have been avoided (and no I’m not talking about Parkinson's disease or other neurological condition). Shoot me if I ever get to that stage. Actually you won’t have to because I will have self-terminated before that humiliation occurs.

The result of fatty encroachment into muscle may result in (and be partly caused by) insulin resistance (it’s a kind of ‘chicken and egg’ scenario) and insulin resistance places us at increased risk of developing type II diabetes. However it has been shown in studies that short, intense bouts of interval training (so-called HIIT) will prevent or delay the onset of insulin resistance by warrant of activating GLUT4 glucose transport units. In other words… EXERCISE is key.

The loss of contractile proteins that occurs with age is chiefly due to a loss in testosterone and other sex hormones, but is certainly exacerbated by inactivity. In other words… RESISTANCE EXERCISE (so-called ‘weight training’) is key.

However, much like osteopenia, Myopenia can only be delayed, not reversed… unless we create the appropriate hormonal climate.

Now, before you start thinking “urh, testosterone… that is a steroid and that would be cheating… or something… anyway, it’s not for me”, let me elaborate further:

Yes of course testosterone is a steroid, but it is the one our bodies produce naturally and require to operate in a virile manner. Taking supplemental testosterone when one is not competing in a tested sport is in no way ‘cheating’, despite what the media might try to portray.

Testosterone replacement therapy (TRT) is now extremely popular in the USA, and gathering momentum here in the UK (slowly), because it restores QUALITY of life. Whether you are 21 and genuinely medically hypogonadal or whether you are 75 and ‘just fading away’, the use of supplemental testosterone has been shown to improve the health markers associated with a long and happy lifespan. Yes steroid abuse may pose a risk to your long-term health but TRT is NOT steroid abuse. Please do not confuse the two and please do not let the moralistic attitude of the media get in the way of you enjoying a happy, productive old age!

Having been prominent on several internet forums over the years, you would not credit the number of times I have read about men (both young and old) whose lives have been pleasantly transformed by a little testosterone, administered under proper medical supervision. And where ‘proper’ medical supervision has been outdated, dogmatic and improper, self-medication has yielded better results – but that is NOT something you should be considering based upon this article. Remember, this is all just one persons’ opinion. NOT a medical guide.

Myopenia – a summary:

1. You must combine both cardiovascular AND resistance exercise. This preserves both insulin sensitivity and muscle mass (to a degree).
2. All the weight lifting in the world won’t stop your muscles from losing condition with age.
3. Like other age-related degeneration, hormones play a key role.

3. Glycation

This is the process whereby sugar molecules bond with proteins or fats within the body (for the purposes of this article) and ‘crosslink’, leading to reduced elasticity and flexibility.

Since we are discussing the musculoskeletal system, the main areas of relevance are ligaments, tendons and other non-contractile proteins. However arteries, veins, skin, etc are all potentially affected as are nerves and DNA.

How is this relevant? Well as we age, we all expect to become stiffer and less flexible and yes, to some degree this is inevitable (you’ll see that phrase a lot within this series), but is made worse by:

1. Advanced glycation endproducts (AGEs) which are molecules found in things like sugary drinks and processed foods. These molecules love to bind to our own tissues, increasing their stiffness over time.
2. A lack of vitamin C. Vitamin C supports correct collagen formation. Collagen is the underlying protein in all our major connective tissue, including ligaments and tendons.
3. SMOKING – breaks down vitamin c, leading to poor collagen formation. This is why smokers skin ages more rapidly. To some extent, high dose vitamin C may offset some of the damage induced by smoking. Better to give up the cigs though really.
4. Stretching and mobility work – keeps your connective tissue operating as it should… to some degree

Now you may be thinking ‘what, no hormones?’ at this point, but yes of course, there are hormones that can help counteract age-related stiffness. GH from GHRPs would be my chief recommendation, but there are supplements that can help too, such as co-enzyme Q10, l-carnitine etc. These work chiefly by aiding the mitochondrial energy production reaction, which gives cells the energy to undo some of the glycation reactions and repair some of the damage.