Is Frailty Inevitable As We Age?

By E. Dylan Mayer and Emeran Mayer, MD

When people reach their late 60s, many suddenly notice a slow decline in their physical strength, sense of balance, memory and cognitive function, and they realize that they can no longer do some of the things they were able to accomplish easily when they were young a adult. Such a progressive decrease in functions is called frailty, which is generally accompanied by a failure of multiple physiological systems and may include the development of chronic low-grade inflammation, loss of muscle (sarcopenia) and bone mass (osteoporosis), loss of cognitive function, and the increased risk of developing chronic diseases like type-2 diabetes, cardiovascular disease and degenerative brain diseases like Alzheimer’s and Parkinson’s disease. In contrast to physiological healthy aging, frailty is definitely not a necessary consequence of age, and it is preventable as several evidence-based remedies suggest. And we are not talking about remedies promoted by the multibillion dollar pharmaceutical industry which thrives off the consequences of frailty on our health. We are talking about two simple measures everybody can implement into their lives:

The First Step Towards Healthy Aging Is Shifting Your Eating Habits

The traditional Western diet, has been shown to be detrimental to our health, based on the numbers of people affected by chronic diseases of industrialization including obesity, metabolic syndrome,1 cardiovascular and liver diseases, depression, Alzheimer’s, Parkinson’s and some forms of cancer in the US and other developed countries.2 The Western diet is characterized by low intake of fiber and high intakes of animal products, refined carbohydrates, sweets and sugary drinks, which have been shown to increase low-grade immune activation (metabolic endotoxemia).3

A recent publication in the prestigious journal Gut showed that a Mediterranean diet intervention altered the gut microbiome in older people across five European countries, and this was accompanied by reduced frailty and improved health status.4 The gut microbial taxa, which were enriched by adherence to the Mediterranean diet, were positively associated with several markers of lower frailty and improved cognitive function, and negatively associated with inflammatory markers including C-reactive protein and interleukin-17. The diet-modulated microbiome change included an increase in the relative prevalence of several beneficial microbial taxa including Faecalibacterium prausnitzii, Roseburia, Eubacterium, Bacteroides and Prevotella, and these microbial changes were associated with an increase in short/branch chained fatty acid production and lower production of secondary bile acids, p-cresols, ethanol and carbon dioxide. This pattern of microbial metabolite changes is generally associated with a reduction of low grade immune activation not only in the gut but also throughout our body.

The Second Step Is Regular Physical Exercise

With the accelerating rise of industrialization during the last 75 years, an increasing percentage of the population in developed countries have adopted a sedentary lifestyle. Sitting at our desks for prolonged periods of time and working on our computers have become the new normal for human activity, despite the fact that this absence of physical activity goes against human nature. Remember our wooly mammoth hunting ancestors, or the early humans walking and running their way from Africa to Europe. Even though a growing number of people are enjoying the runner’s high and the physical fitness associated with running a marathon, recent evidence suggests that much less effort is needed to achieve a health benefit. For example, going on a 30-minute walk “…every day can increase cardiovascular fitness, strengthen bones, reduce excess body fat, and boost muscle power and endurance. It can also reduce your risk of developing conditions such as heart disease, type 2 diabetes, osteoporosis and some cancers.”5

It has been reported that increased physical activity associated with dietary adaptations, a lifestyle pursued by professional athletes, is associated with changes in microbial diversity and composition compared to those who follow a more sedentary lifestyle.6 Another study showed that athletes had a higher diversity of gut micro-organisms, representing 22 distinct phyla, which in turn positively correlated with protein consumption and creatine kinase. The results provide evidence for a beneficial impact of exercise on gut microbiota diversity but also indicate that the relationship is complex and is related to accompanying dietary extremes.7

A recent study8 led by Dr. Frank P. Hu from the Department of Nutrition at Harvard T.H. Chan School of Public Health also demonstrated that moderate to vigorous physical activity (≥30 minutes/day), when adopted at the age of 50 years, was one of 5 low risk lifestyle changes which can add between 7 and 10 extra disease free years on to the life expectancy of a person, compared to people which do not meet these criteria. The other 4 chnages being a healthy diet, normal body weight, no cigarette smoking and moderate alcohol consumption.

Similar findings9 were reported by a group of investigators from the University of Helsinki led by Dr. Solya Nyberg. In a prospective multicohort study of 116,043 participants from several European countries, a statistically significant association between overall healthy lifestyle score and an increased number of disease-free life-years was noted. Similar to the Harvard study, the lifestyle factors that were associated with the greatest disease-free life years included physical activity, a body mass index lower than 25, the absence of a smoking history and moderate alcohol consumption. Several of these factors were associated with extended gains in life lived without type 2 diabetes, cardiovascular and respiratory diseases, and cancer.

A particularly important part of frailty-slowing muscle training is aimed at your core muscles. Strengthening this muscle group has many everyday benefits, including balance and stability.10 A recent article on Medium featured Mike Harrington, a powerlifting and planking 81-year old.11 After being sedentary for the majority of his life, at age 69, Mike linked up with a trainer, shifted his eating habits and began exercising. His specialty? Planking. For those unfamiliar with planking, it is the holding your body in a push up position but on your forearms and toes, maintaining a straight back. It works many muscles in your body, but works your core the hardest. Mike holds the record for his age, 81, at 10 minutes. The current world record is a little over 8 hours, but how many of us can do a 10-minute plank? It’s not easy by any means.

If you gain anything from this article, it should be that you don’t have to accept the collective viewpoint of millions of people which is propagated by endless evening TV advertisements, that medical advice and consumption of multiple pills for blood pressure, diabetes and cholesterol will guarantee a life free of frailty and associated chronic diseases. The simplest and least expensive strategy to achieve these goals are a healthy diet, a positive mindset and regular physical exercise.