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Posted on Monday May 26, 2025 in Naked Heart
As we grow older, our bodies undergo gradual but significant changes that are not always visible to the naked eye. Among the most critical—yet often overlooked—changes is the loss of skeletal muscle mass, a condition known as sarcopenia. This age-related deterioration in muscle tissue is not just about losing strength; it’s a major contributing factor to frailty, metabolic dysfunction, and diminished independence in later life.
Sarcopenia is the progressive loss of skeletal muscle mass and function. It begins as early as our 30s and accelerates after the age of 60. Without intervention, most adults can lose as much as 3–8% of their muscle mass per decade, leading to reduced mobility, poor balance, increased risk of falls, and loss of metabolic resilience.
Why does this matter?
Because skeletal muscle is not only responsible for movement—it’s also a key metabolic organ. It plays a vital role in regulating glucose and insulin. Every time we consume carbohydrates, our bodies must manage the influx of glucose into the bloodstream. Skeletal muscle is the primary site where this glucose is taken up and stored. If our muscle mass is insufficient, the burden falls on the pancreas to produce more insulin to maintain glucose homeostasis. Over time, this can lead to insulin resistance, metabolic syndrome, and type 2 diabetes.
The good news? The biological effects of sarcopenia can be countered—or at the very least, slowed down—through a combination of dietary and lifestyle strategies. Chief among them is ensuring an adequate daily protein intake.
In the UK, the recommended minimum daily protein intake is 0.75g per kilogram of body weight. However, mounting evidence suggests that this baseline is not enough, especially for older adults, those managing chronic conditions, or anyone engaging in weight loss strategies. In practice, most people are falling short of even this modest target.
Thankfully, modern food tracking apps have made it easier than ever to identify this shortfall. Tools like Doctor Shape and others can analyse daily intake and help users rebalance their meals—whether through whole foods or protein supplements, which can provide up to 25g of protein in a single scoop.
Increasing protein intake does more than just support muscle repair. Protein slows gastric emptying, promotes satiety, and importantly, triggers the release of glucagon-like peptide-1 (GLP-1)—a hormone that:
When adequate protein intake is combined with resistance training—using the muscles under tension—it creates a powerful stimulus to maintain and even increase skeletal muscle mass. This dual strategy improves metabolic health, supports weight management, and enhances overall longevity.
Many adults face the creeping issue of central adiposity—the so-called “middle-aged spread”. This refers to the accumulation of visceral fat around the internal organs, a particularly harmful type of fat linked to cardiovascular disease, insulin resistance, and inflammation.
The rise of GLP-1 and GIP mimetic drugs (such as semaglutide and tirzepatide) has provided a powerful pharmacological tool to combat obesity. These drugs mimic natural hormones involved in satiety and insulin signalling, leading to substantial weight loss in many patients. But there’s a caveat.
Whether weight loss is achieved via calorie restriction, bariatric surgery, or pharmacotherapy, the body does not discriminate: lean muscle mass is often lost alongside fat. Without proper countermeasures, such as high-protein diets and resistance exercise, this can leave patients weaker, metabolically compromised, and paradoxically less healthy than before.
This is why it’s essential that patients undergoing significant weight loss—especially those on GLP-1 mimetics—receive comprehensive lifestyle support, including nutritional education and muscle-preserving interventions.
Thanks to digital health technology, many of the tools needed to correct low protein intake are now in the hands of patients. Food tracking apps can analyse the macronutrient breakdown of meals, allowing users to make informed adjustments. AI-based platforms can even suggest personalised meal plans that hit protein targets while remaining aligned with caloric needs and dietary preferences.
For adults using GLP-1 medications, protein needs may increase to 1.2–1.3g per kilogram of body weight per day, reflecting the higher requirement to preserve muscle mass during fat loss. This compares to the general recommendation of 0.75–0.8g/kg/day for healthy adults.
A simple calculation:
A 70kg adult should aim for:
Achieving this is possible through a mix of lean meats, fish, eggs, dairy, legumes, tofu, and protein supplements if needed.
Protein alone is not enough. To retain—or grow—skeletal muscle, resistance exercise is essential.
While walking and other forms of aerobic activity are excellent for cardiovascular fitness, they don’t provide sufficient stimulus for muscle hypertrophy. In fact, many patients who track their daily steps may assume they are doing enough, but without upper body or resistance work, they may continue to lose muscle with age.
Simple additions such as:
A combination of 2–3 resistance sessions per week is ideal for stimulating muscle protein synthesis and preserving lean mass during ageing or weight loss.
Monitoring changes in body composition is another critical part of the strategy. While traditional bathroom scales offer weight tracking, they don’t differentiate between fat mass and lean mass.
Fortunately, there are now affordable at-home body composition scales that use bioelectrical impedance analysis to estimate:
Although not perfectly accurate, these tools are useful for identifying trends over time. When interpreted cautiously, they provide motivation and valuable feedback.
For more precise measurement, periodic DEXA (dual-energy X-ray absorptiometry) scans remain the gold standard. These can track changes in:
Clinics using pharmacological interventions, such as GLP-1 mimetics, should ideally incorporate DEXA scanning into patient follow-up to ensure lean mass preservation. For example at Surrey Cardiovascular Clinic, DEXA scans, home equipment and food analysis apps are all used as part of the metabolic toolkit offered to all patients attending our GLP-1 mimetic clinic.
Ultimately, muscle is a metabolic currency—one we must protect and invest in throughout life.
Without adequate skeletal muscle, we become metabolically fragile, vulnerable to insulin resistance, type 2 diabetes, falls, fractures, and frailty. But this future is not inevitable.
By combining:
Protein is not just for athletes or bodybuilders. It’s a fundamental macronutrient that should be considered preventative medicine, especially in middle age and beyond.
For patients, clinicians, and health systems alike, the message is clear: prioritise protein, protect muscle, and preserve independence.
In the pursuit of longevity, strength is more than a physical attribute—it’s a metabolic safeguard, a symbol of resilience, and a foundation for quality of life.
The Naked Heart is an educational project owned and operated by Dr Edward Leatham. It comprises a series of blog articles, videos and reels distributed on Tiktok, Youtube and Instagram aimed to help educate both patients and healthcare professionals about cardiology related issues.
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