Functional Health Services for Your Well Being

Only Skinny People Die of Old Age

by Alex Boersma


That’s not a knock on skinny people.  Most fat people never get to compete for longevity because their weight predisposes them to diseases which kill early.   After all, when was the last time you saw an obese centenarian?

Truly old people are frail.  In fact, to me, age is defined, not by years, but by frailty.  If you are fifty and frail, you are old.  If you are 80 and robust, you remain young.  The quest for longevity, then, requires the  circumvention of diseases which kill early and the concomitant preservation of robust vitality.  No small task!

The circumvention of disease has been frequently discussed here.  With much more to come.  In this post, though, I would like to focus on the preservation of robust vitality.


At 79 years of age, Clint Eastwood is the epitome of robust vitality.

Although there is obviously a significant element of mental health involved in maintaining robust vitality into your octogenarian years, the focus of this article will be on the physical element.  I believe that mental health is primarily influenced by the factors which act to circumvent disease.  Things like diet, lifestyle and the maintenance of supportive social networks.  To the extent that other factors are involved, I contend that they are primarily physical.  In other words, as long as you avoid things like Alzheimer’s, dementia and loneliness, your mental health generally depends on your physical health.  The more physically able and independent you are, the more likely you will be to exhibit robust mental vitality.

Let me illustrate my point.

Last weekend, my septuagenarian in-laws, on a whim, decided to camp out for the night in their back yard.  To the best of my knowledge, they have never, since I’ve known them, slept outdoors.  Why they decided to do so on this cool fall evening, when a perfectly good bed awaited them inside, is beyond me.  What I do know, though, is that this act was a display of robust vitality.  If they suffered from dementia, one might argue that they simply forgot to go to bed.  But they suffer from no such disease…their minds remain nimble and open to new experiences.  If, however, they had difficulty with things like getting up off the ground, they might never have given the idea a second thought.  The fact that their bodies remain strong and able allowed them to indulge a whim which many others would scarcely entertain.

Camping…for the young at heart!



Strength, power, muscle mass, mobility.  These are the things we are expected to lose as we age.  And I’m not just talking about old age.  Most people I know in their forties are nowhere near as physically capable as they were in their twenties.  Is this an inevitable consequence of ageing?  I think not…at least, not in your forties!  It is, however, an inevitable consequence of being too busy, too lazy, or too tired to prioritize  your own fitness over the plethora of other activities which make demands on your time and attention.

Sadly, even many of those who do manage to dedicate some time and attention to the maintenance of health end up doing the wrong things.  They jog when they should be sprinting.  They lift light weights when they should be lifting heavy weights.  They stretch when they should be strengthening.  They limit their range of motion when they should be expanding it.   Instead of getting stronger they get weaker.  Instead of gaining power they gain endurance.  Instead of building muscle mass they lose it.  And instead of improving their mobility they improve their chance of getting injured.


They are being catabolic.  Catabolism….the metabolic breakdown of complex molecules into smaller ones.  In this case, the metabolic breakdown of muscle mass into energy.  What’s the best way of becoming catabolic?  Chronic endurance training in conjunction with a low protein diet.  Ever wonder why so many chronic exercisers look frail?  Because they fall into the high carb diet/steady state cardio crap/trap which for the last 30 years has been espoused as the road to health and longevity.

Here’s the thing.  Exercise is catabolic.  Regardless of the type of exercise you choose, muscle tissue is inevitably broken down.  This may be news to many of you.  The majority of mainstream exercisers firmly believe that training, particularly resistance training, makes muscles get bigger.  After all, isn’t that how bodybuilders get to be so, uh…bodybuilderish?

Doesn’t resistance training make you look like this?

Not exactly.  Exercise, as we said, is catabolic…it breaks down muscle.  This muscle breakdown is the stimulus for muscle growth…if conditions for growth are optimized!  Let me repeat that last part:  If conditions for growth are optimized.  Let me re-phrase that.  You can exercise until the proverbial cows come home, but if you don’t optimize the hormonal response to exercise, you will become skinny, injured and weak!

Not that there is anything wrong with that!

The appropriate dose of exercise will stimulate muscle growth, but only if it is complemented by appropriate doses of nutrition and rest.  The tricky part is the dosing.  So what are the appropriate dosages of exercise, nutrition and rest for promoting muscle growth?  You, see, that’s the tricky part.  Nobody really knows exactly.  If anybody did know exactly…then the magazine racks wouldn’t be full of magazines with guys like the one above (okay, maybe not quite like him) providing you with a gazillion different “optimal” doses of exercise and recovery.

But there are a few things I do know:

I know that chronic cardiovascular training will not do it. Spending hour after hour running or pretending to be a hamster on a piece of gym equipment simply does not build muscle.  Cardiovascular training stimulates the conversion of fast twitch muscle fibres to slow twitch muscle fibres.  It stimulates increased mitochondrial density and capillarization.  Even if you do provide appropriate doses of rest and nutrition, you just get to be better at performing relatively non-powerful  movements for longer periods of time.  If you don’t (and if you subscribe to the typical bagels, bananas and business meetings high carb/type A runner’s lifestyle, you are almost guaranteed not to) then you get to lose precious muscle mass.

I know that “body pump” fitness classes won’t do it either…at least not for long.  Neither will yoga nor Pilate’s nor any of the myriad other programs which profess to build “long, lean, dancer-like” muscles.  Please understand.  Unless you are 18 years old and swimming in testosterone, building any kind of significant muscle mass is extremely difficult.  It requires near-pathological dedication to the principles of muscle stimulation and recovery.  The most important of these is the principle of progressive overload.  This principle states that the stimulation required for muscle growth is overload.  In other words, in order for a muscle to grow, it needs to do something which it hasn’t done before.  In practical gym terms, this usually means lifting a heavier weight than you did last time.  Unfortunately, in a “body pump” style class, the weights don’t usually get very high.  Yoga and Pilate’s don’t even use weights…they just use body weight and gravity.  Although some progression can be achieved through variations in range of motion and angle of force, true progressive overload is limited.  These modes of exercise, then, build muscular endurance rather than muscle mass.  Not that there is anything wrong with that either!  They just don’t have the tools to provide adequate muscle growth stimulation.


This isn’t likely to build muscle mass 



But this sure will!

If you want to preserve robust vitality, you are simply going to have to lift some weight.  It doesn’t have to be particularly heavy when you start, but if you want your muscle mass to grow, you’d best make sure your weights grow.  Do not be afraid!  And for the “I don’t want to bulk up” crowd, here’s something to think about.  The girl in the picture above spent years in the prime of her life doing everything just right to  get into the shape she is in. She can and does lift much more weight than I can.   And yet, she is by no means muscle bound.  She is just strong and athletic.  If you are not in the prime of your life and/or you don’t have the near-pathological dedication to exercise and nutrition that she has, your chances of “bulking up” are just about nil.

Muscle mass is just too important a factor in health and longevity to be feared.  And I’m not just talking about the ability to get your butt on and off of the toilet.  Lean muscle mass is substantially associated with something called organ reserve.  Organ reserve is the capacity your organs have for recovering from trauma.  It is estimated that if you are a young, healthy adult, you have an organ reserve of 7 to 11 times normal capacity.  By the time you turn 85, though, you will probably have lost more than 50% of that reserve.  In other words, an ailment which would barely touch your ability to recover in youth could easily overtax your system when you get old. 

The immune system runs on protein.  When you get sick, your immune system takes protein out of storage to beef up the immune response.  Guess where most of your protein is stored?  In your muscles.  If there is insufficient protein stored in the muscles, the next protein depots to be scavenged are the various organs.  If your organ reserve is already depleted, it won’t be long before those organs go into failure.  Multiple organ failure is a fairly common consequence of simple illness in the elderly.  It usually comes with a “died from natural causes” byline on your obituary, there’s many health problems that can make organ failure a lot more common; therefor, it is recommended to start paying attention to the early signs, once a person reaches certain age it could be better to opt for a care center.

The importance of maintaining sufficient protein flux during illness is well recognized in the medical community.  To the point where higher protein diets are often recommended prior to surgery or post-operatively.  While such dietary intervention can certainly benefit the elderly in times of sickness,  it can not make up for a lack of adequate protein storage.  For that, you will need some muscle mass.


You are never to old to lift weights!

The truth is, there is never a better time than now to start lifting some weights.  The medical literature is rife with references to the benefits of resistance training for the elderly.  I have included one abstract below:

J Gerontol A Biol Sci Med Sci. 2003 Oct;58(10):M918-22.

Exercise, aging, and muscle protein metabolism.

Yarasheski KE.

Washington University School of Medicine, St Louis, Missouri 63110, USA.


Age-associated alterations in muscle protein quantity and quality that adversely affect muscle structure, composition, and function have been referred to as sarcopenia. Muscle protein is metabolically active, and the age-associated loss of muscle protein mass is related to a loss of physical function and an inability to perform activities of daily living (physical frailty). It is important to maintain adequate reserves of muscle protein and amino acids as we age. As in all cachectic conditions, sarcopenia can be explained by an imbalance between the rates of muscle protein synthesis and muscle proteolysis, in which net muscle protein balance is negative. This review summarizes evidence that supports the notion that: (a). advancing age and physical frailty are associated with a reduction in the fasting rate of mixed and myosin heavy chain protein synthesis, which contributes to muscle protein wasting in advancing age; (b). this impairment can be corrected because resistance exercise acutely and dramatically increases the rate of muscle protein synthesis in men and women aged 76 years and older; and (c). resistance exercise training maintains a modest increment in the rate of muscle protein synthesis and contributes to muscle hypertrophy and improved muscle strength in frail elderly men and women. The cellular mechanisms responsible for these adaptations, as well as the role of nutrition and hormone replacement in reversing sarcopenia, require further investigation.

“resistance training acutely and dramatically increases the rate of muscle protein synthesis in men and women aged 76 years and older”


You can and should use resistance training to increase your lean muscle mass at any age.  If you do, your chances of remaining vitally robust into your octogenarian years will increase substantially.  You won’t have to buy yourself one of those raised toilet seats.  You won’t have to decline a chance to go camping in your back yard.  You won’t have to concern yourself about dwindling organ reserve.  And, most importantly, your obituary won’t say “He died because he was too skinny!”

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