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ASK THE DOCTOR: How can I bulk up my wasting muscles?

Weight to go: From 50, we lose 0.5 to 1 per cent of muscle strength per year

I’m closing fast on 80, and am horrified at the rapid disappear-ance of what used to be good, working muscles. Would protein drinks used by gym-goers help rebuild my muscles? Or is there something else I can try?

Name and address supplied.

Reading your longer letter, I get the impression that you’re in good general health and taking regular exercise, and yet, at fourscore years, you have spotted some muscle loss.

This is a natural phenomenon that comes with age, known as the sarcopenia of age: it starts from our 30s but accelerates as we get older, so from 50, we lose 0.5 to 1 per cent of muscle strength per year.

Lack of exercise can make sarcopenia worse, as we lose muscle mass when we are inactive for long periods, such as while recovering after an operation.

But even top-class athletes who continue to train throughout life are known to suffer from progressive loss of muscle from the age of 30.

The cause of sarcopenia of age remains unclear, but evidence suggests that, as we get older, there are changes relating to the protein in our muscles.

Normally, muscle tissue, which is made up of protein fibres, is in a constant process of breakdown and rebuilding. Muscles need to be constantly used to maintain this normal physiology and keep them functioning well.

With ageing or disuse, protein breakdown starts to outstrip the ability to form new protein — so muscles gradually become smaller and weaker.

Research has confirmed that increasing dietary protein does, in turn, increase the formation of new protein and build muscles.

This has been tested in patients who have been in a state of ill-health, rather than in those with sarcopenia of age specifically, but the physiology of building muscle tissue is the same.

The protein in food is broken down by the gut into amino acids, the building blocks our bodies use to make the proteins used for muscle cells.

In particular, studies have shown one amino acid, leucine (found in all foods that are high in protein, such as meat) is an important trigger for muscle building.

Natural: Even top-class athletes who continue to train throughout life are known to suffer from progressive loss of muscle from the age of 30

Natural: Even top-class athletes who continue to train throughout life are known to suffer from progressive loss of muscle from the age of 30

In the body, leucine is converted into another component — beta-hydroxy beta-methylbutyric acid (HMB) — which has been shown to increase muscle size and strength by both stimulating the building of muscle protein and inhibiting protein breakdown.

HMB is also naturally present in some foods — including grapefruit, asparagus and avocado — so you can get this crucial chemical by eating plenty of these, too. Of course, you can also get both leucine and HMB in supplement form, but this is unnecessary, even for gym enthusiasts.

The kind of protein supplements marketed for gym-goers to help bulk up muscle are nothing more than a commercial con: they give nothing that cannot be obtained from normal food and an exercise routine designed to build muscle — in particular, resistance training, such as weight-lifting.

I believe there is sufficient evidence to support the addition of HMB and leucine into your diet, as well as regular resistance training. Together, these must be the cornerstone of your approach to rebuild lost muscle and keep it strong.

There are also some supplement drinks that are useful, such as Ensure or Juven, which are given to patients recovering from major surgery. They contain extra HMB and leucine and have been proven effective and safe long-term.

I was involved in a traffic accident in February while travelling on a bus and have been having panic attacks ever since. My left arm also hurts when I move it. Is there anything that can help? I am 23.

Amy Sadler, New Malden, Surrey.

You have my sympathy — the traffic accident must have been traumatic for you and it has clearly left you with a number of significant symptoms.

As you describe in your longer letter, you continue to suffer sleep disturbances, flashbacks and episodes of panic.

To me, this suggests a diagnosis of post-traumatic stress disorder (PTSD). This causes symptoms such as recurrent upsetting memories, where you ‘see’ or feel the trauma all over again — just as you describe.

Upset: Post-traumatic stress disorder (PTSD) causes symptoms such as recurrent  memories

Upset: Post-traumatic stress disorder (PTSD) causes symptoms such as recurrent memories

PTSD can be triggered by many life events, but why it happens to some people and not others is unclear. And why it would cause the brain to repeat such stressful episodes and cause panic attacks is also not clear, as a psychiatrist who is an expert on the subject told me.

The condition can occur at any age and is not necessarily proportional to the severity of the trigger event — it is the fact that there was a chance of serious injury or death that causes lasting effects.

Write to Dr Scurr 

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email — including contact details. 

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

Always consult your own GP with any health worries.

To overcome your PTSD symptoms, you need a referral to a clinical psychologist or psychotherapist for cognitive behavioural therapy (CBT), a talking therapy. On occasion, patients are prescribed anti-depressant medication in addition to this, but this will depend on your specialist’s assessment and your suitability.

In terms of the continuing pain in your arm, there may be inflammation, or a trapped nerve, that’s still causing problems seven months later.

The fact that you’ve continued to use your arm, the weight of which would have perpetuated the inflammation, is likely to have made the pain worse over time.

There is also a condition called complex regional pain syndrome, which can follow the type of injury you suffered. One characteristic of it is experiencing worse pain than might be expected from the nature of the injury.

Ask your GP for a referral to a physiotherapist for a more accurate, anatomy-based diagnosis and subsequent treatment, which will include some form of massage and relevant exercises.

But I would suggest you first seek help for your post-traumatic stress. You may find that the pain in your arm resolves when your psychological symptoms are under control, as there is often a psychological component to experiences of physical pain, too.

This therapy will eventually prompt a full recovery: there is every reason for optimism.


The latest initiative by the NHS to reduce the incidence of strokes and heart attacks is to train firemen to carry out blood pressure checks. Supermarkets, offices and schools will also have blood pressure machines.

This is already happening in some parts of the UK and, while I applaud the plan as a way to equip everyone with these vital skills, it does not go far enough.

We should actually all be checking our own blood pressure.

The causes of high blood pressure are complex, with a number of interrelated factors including excess salt in the diet, alcohol, obesity, lack of exercise, genes and many aspects of our pressurised, sleep-deprived, worry-obsessed lifestyles. The key point is that, for many, the first sign of problematic blood pressure is at a point of no return, such as a stroke causing catastrophic brain damage, or heart failure.

I am not convinced that spending time, energy and money in training firemen to carry out blood pressure checks is the answer, not least because they have other life-saving work to do.

For less than £20, anyone can buy a perfectly reliable blood pressure machine (sphygmomanometer) to check their own blood pressure.

It’s not a lot of money when you consider what most of us seem prepared to spend on a mobile phone.

Crucially, this means we can check our blood pressure at home and keep an eye on the trend.

Or why not teach children at school? They’re learning about science, sex and relationships, so why not add how to use a sphygmomanometer to the syllabus — it takes five minutes to learn.

We all need to know how to interpret a reading. A blood pressure level of over 140/90 is the cut-off point between normal and abnormal.

And remember, one swallow does not make a summer, so one elevated reading may just be anxiety or a bad moment.

What matters is the trend of a few regular measurements — and how often can you ask that fireman to come back.



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