Brain Body Food E-Book

Ngaire Hobbins

• Herausgeber: WS
• Kategorie: Ratgeber
• Sprache: Englisch

Seitenzahl: 359

Veröffentlichungsjahr: 2021

Beschreibung

This unique book delivers the latest science in nutrition, ageing and dementia risk reduction in everyday language - so you can enjoy the life you had planned for the years ahead.

You will learn food and life choices crucial to preventing avoidable physical and cognitive decline and the stark difference between those at 40 or 50, compared to what's needed as you move closer to your 80s and beyond.

Most popular health and eating plans are ideal for those in their 20s, 30s or 40s, but can be anything from unhelpful to downright harmful if you are heading towards or beyond your 70s.

Brain, Body, Food gives you the insights into understanding that and knowing how to adapt your focus to avoid harm and relish life as you age. It is about eating and living to:

· Help your body meet the unique challenges of ageing

· Reduce your dementia risk

· Strengthen your immune system

· Head off preventable physical decline and more.

Ngaire Hobbins - dietitian/nutritionist specialising in ageing and brain health - skilfully presents the latest science in everyday language, to help you enjoy real food and achieve peak body and brain function as you age.

Leseprobe

Author: Ngaire Hobbins

ABN: 25 699 506 380

Website: www.ngairehobbins.com

Facebook: www.facebook.com/ngairehobbinsdietitian

Instagram: ngairehobbins_dietitian

Twitter: @NgaireHobbins

Copyright © 2020

First Published by Ngaire Hobbins November 2020 Revised February 2021 The moral rights of the author have been asserted. All rights reserved.

This book may not be reproduced in whole or in part, stored, posted on the internet or transmitted in any form or by any means, whether electronically, mechanically, or by photocopying, recording, sharing or any other means, without written permission from the author and publisher of the book. Please feel free to email me for permission – I’m usually obliging. All content found on or offline without written permission from me will be breaking the copyright law and therefore, render you liable and at risk of persecution.

CONTENTS

Preface

Bodyworks

1) Muscle: Your Anti-Ageing Frontline

2) A ‘Wicked Problem’: The Need to Consider Bodyweight Differently at Later Age

3) Helping Your Bones to Help You

4) Born to Move: Exercise and Activity for Life

Brainworks

1) The Active Brain

2) Brain Resourcing: Fuel, Fluids, Nutrients

3) When Things Go Wrong: How, When, What/Why?

4) Reducing Your Dementia Risk

5) Life with Cognitive Decline and Dementia

Healthworks

1) Diabetes at Later Age: New Thinking is Needed

2) The Blessings of a Good Appetite

3) Relishing Every Mouthful and Eating Safely

4) Resourcing Your Body for Surgery and Cancer Treatment

5) Moving Along: Managing Bowel Concerns

Foodworks

1) Getting What You Need From Food

2) Eating Plans to Guide Your Day

3) Some Recipes and Meal Suggestions

Further Reading and Resources:Places To Go To Learn More

PREFACE

Thank you for picking up this book!

I wrote it for you who are interested in food, ageing and brain health. I am passionate about sharing my understanding of the current evidence on eating and living to enjoy the very best life into later years with everyday people and health professionals alike.

I am a clinically trained dietitian holding a Bachelor of Science degree with postgraduate qualifications in Nutrition and Dietetics. I am acknowledged as an authority in nutrition and ageing, and am a skilled presenter to groups of everyday people as well as professional audiences nationally and internationally.

The endless background chatter of self-proclaimed diet and nutrition gurus with little or no professional training in nutrition can make deciding what to eat from the tens of thousands of foods we encounter every day—many of which bear no resemblance to their healthy origins—challenging for those who just want to know how to live fulfilling, happy lives.

One of the wonderful benefits of significant life and career experience for me has been confirming what I always knew instinctively but is also increasingly supported by the weight of evidence—that my grandmother was doing most of the right things and fresh, minimally processed and, ideally, locally sourced food holds the answers to living well. About two decades ago I started working exclusively with older adults and discovered an almost complete lack of helpful, practical guidance specifically tailored to the needs of people enjoying unprecedented longevity.

Far too often in my clinical work over these years, I have seen physical and cognitive decline result from unawareness that nutrition needs beyond your mid 60s are not the same as they were in your younger years.

The blessings gained from longer lives also mean our bodies and brains need to endure the wear and tear of everyday life and continue to function for longer than they did in previous generations. Without a clear focus on the specific needs of living into these years, you become more vulnerable to infections, illnesses, wounds and falls and will struggle to recover from these. Fortunately, there is now a wealth of information available to help minimise the risk of physical and cognitive decline and to support these unique nutrition needs, so you can make the most of life as you grow old. My work is all about sharing that with you.

This book had its beginnings in my frustrations at seeing too many clients with physical and cognitive issues that could have been avoided had they understood the unique differences between the nutrition needs of their younger and older selves. I released Eat To Cheat Ageing in 2014 to counter the lack of good information and when the science of nutrition and brain health subsequently exploded, followed that in 2016 with Eat To Cheat Dementia. I have been asked many times to combine these books, so when an update was due I made the decision to do just that, merging the content into one manual for life into later age: Brain, Body, Food is the result.

Writing is somewhat of a necessary evil for me. It’s my way to share knowledge with as many people as possible but is not a process I find comes easily and all that time spent in my head wrangling tens of thousands of words has wide ranging impacts on those around me. I fear that is most felt by my endlessly supportive and encouraging family—especially Craig and Jackson who again tolerated many months of a present-yet-absent wife and mother. I am so thankful to them and so many others: to my mother who believes I can achieve anything, to my regrettably more physically distant but equally adored and appreciated Nell, Angus, Anastasia and Mark, to Cathie, Penny, Vicki, Rosie, Anne-Marie, Ange, Robyn, Catherine and Sharee, the team at COTA Tasmania and my dad and Elaine who have patiently listened over and over to my frustrations and crazy ideas. To the wonderful Genevieve Lilley who let me be her very first ‘writer in residence’ in her glorious Cradle Mountain cottage. To my greatly loved and missed Avoca Beach book group and to the ‘world’s best geriatrician’ Dr Peter Lipski, who together sent me on this path. And this book could never have come into existence without Rachael Bermingham’s support, encouragement and excellent production coordination, all delivered with the perfect balance of fun, exuberance and professionalism.

Thank you all—this could never have happened had so many supports not been in place.

And may all who read this book enjoy fulfilling, joy-infused lives relishing every mouthful.

BODYWOORKS

PART 1

Muscle: Your Anti-Ageing Frontline

Did you know the key to living a long and healthy life depends on more than merely avoiding illness? It lies in your muscles.

It’s true. Muscles do a lot more than move you around—they hold the keys to you living the life you had hoped for in the years ahead. And they are more vulnerable than you might imagine.

You may have managed to keep up gym work, cycling, swimming or whatever is your thing, and secretly gloat over how athletic you look or maybe your muscles are now hidden by an extra bit of padding. No matter what’s obvious on the surface or how you might feel, the unseen changes caused by inactivity, age, wear and tear, illness and stress can rob you of muscle minute by minute.

Why is that important?

Muscles do more for you than you may realise. They help maintain every one of your body’s organs, help you avoid type 2 diabetes and ensure your brain is adequately fuelled to coordinate all your activity and keep your mind firing as you’d like it to. Muscles keep blood coursing in your veins to move oxygen, nutrients and fuel through your body. They also help you fight illness and infection and are essential for repair work, from everyday bumps and bruises to tissue, bone and tendon repair after major surgery.

Unfortunately, muscle loss is not always obvious until it has progressed far enough to have disastrous impact on physical and cognitive capacity, so being aware of its significance and working to head off any loss is essential. Medical advances may have managed to conquer illnesses that once claimed lives at a younger age, but making the most of the extra 20 years or so they have given us depends on finding ways to keep your body—especially your muscles—and brain going a lot longer than our grandparents might have needed to.

Generations ago eating meant hunting and gathering, and that meant running, climbing, throwing, digging, carrying really heavy stuff like whole animals, and walking, walking, walking. If you wanted to eat, you had no choice but to keep your muscles working. The hunter–gatherer lifestyle is no longer a career option and we have become far too good at finding ways to do less and less activity, which is bad news not only for our muscles but also for our immune system, our body organs and our brains. Nobody wants to return to the days of scrubbing floors on hands and knees, walking miles to work every day, or living without mod cons, but although these bygone lives seemed hard, they worked muscles as they needed to be worked.

My grandfather was born in the early 1900s. In those days 65 was considered a ripe old age—well and truly time to retire on the old age pension and potter around the house. Nowadays 65 is positively young! People expect far more from their remaining years than the generations before. We want to be able to travel, to get down and dirty with the grandkids, to embrace new technology—Skype, Facebook, perhaps online dating—and maybe take up belly dancing or skydiving.

Grandad had to chop and split wood and carry it up to the house every day just to get a cup of tea in the morning. He had to push a hand-mower across the lawn each Saturday; and if something had to be repaired, out came the hammer, the handsaw, the hand-drill and the manual screwdriver. Today we push a button to boil the jug, push a button to start the mower, which almost drives itself; and we can’t imagine life without the electric drill, the chainsaw and perhaps even the electric nail gun.

Grandma did her washing in the copper, dragging each item out of scalding water with a stick and putting it through a hand wringer. If the sheets dared bunch up too much, the wringer had to be released, the washing unwound from the rollers, and the whole process started again. Then the very wet and heavy load had to be carried out to the washing line. The line was a floppy wire strung across the yard and propped up with long poles that needed to be angled low when Grandma pegged out the washing, then re-angled to hoist the washing higher to avoid dogs and small children playing in the washing as it dried (try doing that with a heavy load of wet washing on a line). She was judged by her good housekeeping and religiously mopped the floors and dragged the carpets bodily out of the house, draped them over the back fence, and beat the dust out of them with a cane carpet beater. She made cakes as light as air using only a wooden spoon, a hand-beater and elbow grease.

It’s ironic: we’ve become so clever in thinking up endless arrays of gadgets and machines to do physical chores for us that we’ve outpaced the way our body systems have evolved. The fact is they still depend on us to keep them functioning well in order to continue to go about their work. I need to go to the gym to achieve the sort of strength and muscle Grandma took for granted.

The older you get, the more important muscles become.

It’s fortunate that there is a lot you can do to keep your muscles up to scratch. Understanding what your muscles need is pivotal, and to do that you need to understand the role of what you eat. None of us want to give up our TV remotes, our washing machines or our electric drills, so we need to find alternative ways to keep the life in our muscles. That means not only staying active and doing exercise that boosts muscle, but also feeding them right, and that’s about changing the focus from eating to avoid illness, to eating to age well.

Most health messages are aimed at the population as a whole and are often about avoiding the big baddies like heart disease. Those same messages need a different emphasis when you are looking to life ahead, beyond your late 60s. Of course it’s still important to do what you can to avoid heart disease and other preventable illnesses—but living well into later age needs to be about more than preventing illness.

What you eat and do as you move beyond your 50s and 60s needs to be about tricking your body into thwarting what its physiology—the body’s processing and functioning—naturally inclines it to do, which is to gradually slow down. Slowing down physiology-wise can mean your body systems not working as well as they once did. Thankfully though, while your muscles are affected by those system changes, they mainly slow down due to underuse but remain able to help you no matter your age, if you help them. Sure, illness can take a toll, but keeping your muscles working, and eating to support them is a pathway to heading off age-related physical and cognitive decline—giving you the power to make the most of the 20 or so years ahead.

To look more closely at how easily the wheels can fall off, consider Joan and Betty:

Joan and Betty did most things together. There was golf, a bit of tennis, plenty of socialising and getting out and about with friends and families. Joan was always just a bit more active and always seemed able to eat yet stay thin, while Betty struggled to keep her weight down most of her life. Both slowed down a bit from their mid 50s, but not enough to cause any concern. Life was good and they felt they’d earned a chance to rest up a bit.

However, as Joan did less she also found herself feeling less hungry, and her meals became smaller. She was conscious of maintaining her health and read up on various diets. Her daughter had recently had success with one where she ate mostly fruit, salads, vegetables and wholegrain foods, with just occasional meats and fish and some low fat dairy foods, so Joan took that on. Her friend Betty just enjoyed her food too much to cut down. She tried to share her friend’s interest in her diet and managed to go along with it some of the time, though not always with the same determination or success.

When Joan lost some weight she wasn’t worried. She felt quite virtuous. Betty didn’t lose any but didn’t gain either, so felt she was doing okay. By 68 they both felt well and were living good, healthy lives.

This all seems perfectly reasonable and appropriately healthy, right? Wrong!

There are some red flags in this picture that may surprise you. They are weight loss, eating smaller meals, and eating fewer high-protein foods. Joan was well intentioned, but while the diet she chose was great for her 43-year-old daughter, it was not the best for her.

Age imposes unique nutritional needs, no matter how well you eat or what you weigh. What Joan and Betty didn’t know is that losing weight when you are older means losing muscle, and that sets you up for poor health ahead. Those smaller meals Joan had been choosing along with less meat and dairy, meant getting fewer essentials, like protein.

Now is the time to review and realign your ideal food choices, even for those of you like Betty, who felt so far from Joan’s lack of interest in food and her ability to gradually lose weight that she might as well have inhabited another planet. Of the two, Betty was actually better off when it came to staying independent and healthy into the future.

That ‘healthy’ diet you might have been trying hard to stick with may no longer be right for you.

We’ll come back to the girls soon—let’s look in more detail at the hidden benefits of body muscle.

Figure 1:

Body muscle helps you in more ways than you might expect. It:

›Supports your immune system so you can fight infection and illness

›Supports repair of wounds and recovery from illness

›Helps you to continue to swallow safely and effectively

›Helps maintain a healthy appetite

›Helps your body use its insulin effectively to avoid diabetes developing or its symptoms worsening

›Helps keep fuel supplied to your brain

›Helps you avoid having an adverse reaction to a medication

›Stops you from falling should you lose balance or miss your step

›Allows you to keep moving around engaging in physical activity

›Supports your joints to reduce the pain of arthritis and maintain flexibility.

WHY MUSCLE IS MORE TO YOU THAN MERELY WHAT MOVES YOU

Your muscles are your reserve supply of body protein.

Why is that important? Because protein is constantly being used to fight illness and infection, do the body’s repair work, keep body organs functioning and help support brain fuel supply.

Every little thing your body has to do every minute of every day means wear and tear on your cells. And every cell in every organ—in your skin, your gut, your blood, as well as all the substances running the systems that keep you alive—has a lifespan. Some have only hours of life, some days, some months before they are replaced. Protein is used minute by minute to address wear and tear, to repair damage and for constant renewal. At the same time it’s helping fight off infection and fuelling your brain—as we’ll see later on.

I eat food, and food contains protein, so what’s the problem?

It’s more about continuity of supply: we don’t eat 24 hours a day, but protein is needed all that time. That’s where the muscle protein reserve comes in.

It’s rather like your car. Once you turn that key, you expect to be able to travel a long way. Your car needs fuel to keep running but you don’t carry the petrol station or the power source around with you for that constant supply. Your car’s fuel tank or battery is your reserve between fill-ups; and muscle is our protein reserve between food fill-ups. Unlike your car, which you can switch off when its work is done, the demand for protein doesn’t stop, even when you are sleeping or relaxing on the couch, and there are always going to be gaps between protein coming in from food.

Protein is released from your muscles to bridge those gaps, which come along surprisingly often: they include the non-eating hours between meals; the times when you are unwell and just can’t eat properly; or if you fast—for medical, religious or other reasons. And there are always days when you just don’t get time to eat the meals you should.

In a car you start with a full tank, travelling along at whatever pace you choose. If you don’t refuel, a time will come when you will just stop. It’s different for your body—it’s not all or nothing. If your protein reserve dwindles enough, all the systems that rely on it start to falter and you face more of a series of steps down towards a slow, grinding halt.

Fortunately, even those of us who don’t look like Mr or Ms Universe are blessed with a start-up muscle supply that is built as we grow to peak adulthood. That supply can easily keep us cruising along until about our mid 60s. And let’s face it, anyone now in their later years understands that not long ago, 70 was positively old!

Nowadays the extra two or three decades mean muscles need some help if they’re going to be that protein reserve: to keep you moving, but also to help you fight illness and infection, repair injuries, keep your body organs running, avoid type 2 diabetes (or manage it if you already have it) and more.

Holding onto the muscle you have, boosting it if needed and replenishing it as much as possible will always keep plenty of protein in reserve for when you need it.

Back to Joan and Betty:

Around comes the cold and flu season and Joan succumbs. You know what it’s like with the flu—you don’t always feel like eating. Joan’s muscle reserve starts furiously releasing protein to augment what little food she is able to eat. Her immune system is able to rage along on the protein reserves supplied by her muscles while food isn’t available to do the job, and Joan recovers.

Betty and other friends are shocked when they see her next— she has clearly lost weight. Joan is not as concerned. She thinks weight loss is always good.

She is mistaken, a lot of the kilograms she has lost will be muscle (read more about this soon), which has the potential to cause her more harm than good, even if she has lost some body fat.

For things to reset to how they were before her illness, Joan needs to replace the muscle (and protein reserve) she has lost, not to mention the weight loss prior to that. Betty would be in a better position, not having already lost weight. It’s Joan who is the concern—and this is where age raises its somewhat unattractive head: the older you get the harder it is to rebuild muscle. Not just because exercise becomes less appealing, but also because of the age bias of our physiology.

WE ARE PHYSIOLOGICALLY DRIVEN TO GROW THAT ADULT BODY, BUT NOT TO GET BIGGER ONCE WE GET THERE

Humans are beautifully designed with systems, which use the food we eat and oxygen we breathe from our first moment on earth to build the body we achieve at peak adulthood—around our mid 40s. However, if that growth continued, we would all be giants by 60! That’s clearly not the case: things change.

On the way to your peak, the more you use your muscles, the more they build and support your health in a myriad of ways; even without doing much muscle work, you are hard wired to grow and build them. And if any get lost because your muscle reserve is needed temporarily to provide protein for rescue work, this convenient programming drives rebuilding as soon as you eat again.

That programmed rebuilding relies on a combination of three things:

1.Messages from hormones

2.Signals from nerves

3.The activity of the muscles themselves.

And here’s where our bodies’ ageist physiology strikes against us. Hormone levels diminish and the signals from nerves dwindle with age. From as early as your 30s or 40s both are affected, and by your mid 60s the hormone and nerve boosting of muscles that built you up to your peak structure, has all but ceased.

That leaves muscle activity alone in the rebuilding task—but your muscles are reminded to repair and build only when you work them. Fortunately, even though it gets more difficult to completely rebuild the older you get, that system does keep working as long as you live.

So, if your body is to have any chance at all of keeping pace with the plans you’ve made for the years ahead, it needs your help. Those flabby arms and bingo wings, flibberty bits, saggy bottoms and turkey necks may be gravity’s joke, but under that exterior it’s up to you to nurture your inner Adonis. That means considering five things:

1. Eating for your muscles: protein, protein, protein.

Ironically, after all those years when most of us seemed to struggle to keep our meal sizes within civilised boundaries, when we were often being told to eat less meat and dairy and that the pinnacle of good nutrition was a plate piled to the ceiling with salad and veggies topped with nothing but a squeeze of lemon, the time has now come for a lot of that to be turned on its head. Not everyone is going to find they eat less food as they get older, but improbable as it seems, many of us will. And while all those lovely vegetables, fruits and leafy things provide irreplaceable vitamin and antioxidant boosters, the meats, cheeses and nuts of this world take on an elevated status from now on.

Why? Because you are still running an adult-sized body no matter how old you are, and it still has adult-sized needs for most nutrients. In fact, with all the extra wear and tear that occurs as you age, you need more of some things than you did when you were younger, and protein is one of them. So the importance of packing extra nutrition into your meals to keep your muscles up to scratch and cheat ageing is undeniable. You don’t have to eat huge amounts of protein foods, but you mustn’t eat less than you did when younger.

People over 70 are thought to need at least 20% more protein than in younger years. Figure 2 gives you a basic guide to protein foods, with much more detail provided later in Foodworks.

Figure 2:

FOODS SUPPLYING PROTEIN

All meats, poultry, offal, fish, seafoods:focus mainly on fresh cuts, enjoying processed varieties like ham, bacon and smoked meats/seafoods less frequentlyEggs:chicken or any otherDairy foods:including liquid, concentrated (evaporated) and dried milk, cheese and yoghurt (but not cream or butter, which like oils, are not high protein) milk, cheese, yoghurt from goats, sheep or otherSoy products:including soy beverages, yoghurt, tofu, tempeh and othersPulses:including baked beans, peas, broad beans, lentils, chickpeas, kidney and similar beansNuts, seeds:all varieties (whole or ground) and products made from them (apart from their oils, which do not contain protein)Hemp products:including seeds, hulled seeds and flour (apart from hemp oil, which has no protein)High-protein powdered supplements:including skim milk powder, whey protein isolate products plant-based isolates and powders from soy, peas, hemp rice and others.

Life is too short to spend thinking about every mouthful you take, so make it easy for yourself: put a good protein food at the centre of every meal and you won’t have to struggle to keep up the supply.

When you ate larger meals, you could easily get away with only having protein foods at some meals or in very small amounts as a ‘garnish’ while vegetables, fruits and grains held centre stage. In fact, that’s the ideal diet plan to combat obesity in younger people, and you might believe it is right for older adults from reading, watching or listening to eating advice in the popular press, online or even from medical or public health authorities.

However, so much of that generalist advice fails to take into account the unique needs of older adults: unless you include a good protein food at most meals you risk not being able to cope with your body’s demands. If you do suffer an illness or an infection you will need to eat more protein to help balance what your muscles will lose so you can repair and recover, but be aware this might mean eating extra protein between meals and for some, high protein drinks or supplements might be necessary. There is more detailed guidance on protein in foods and how to plan to get what you need in Foodworks.

2: Does it matter where the protein comes from: animal versus vegetable?

It doesn’t matter to your body where the protein in your meals comes from. Because you probably aren’t eating as much as you did when you were younger, you need to pack more protein and other essentials into every serve or every mouthful.

Many animal-based foods have an advantage because servings of meat, fish or dairy don’t always need to be as large to give the same amount of protein as they usually do when the protein comes from plant-based foods (such as soy milk, nuts, seeds or grains). The amount of protein in foods does vary as you can see in figure 3, so it is important if you prefer to eat fewer animal-based protein foods that the plant foods you choose give you the protein you need. Head to Foodworks for more on protein in foods and practical strategies to get what you need from your meals and snacks.

Figure 3:

Animal vs vegetable: comparison of approximate cooked serve sizes to get an equivalent amount (20g) of protein

Cheese (cheddar)40g – about half cup grated or matchbox-sized pieceMeat, chicken, fish60g – meat portion (about size of 1 pack of cards)/ 1 lge chicken drumstick/ 2/3 small can tuna/salmon drainedEggs150g – 3 X 50g eggsTofu140g – portion about size of 2 packs of cardsLentils/chick peas220g – a generous cup or half a canNuts/LSA mix200g – about 1 cupMushrooms (fresh)450g – enough to half fill a bucketRice/quinoa660g – about 6 cups

Researchers in sports science and in space programs have looked at which proteins work best in building muscle. For athletes it’s obviously vital to tailor muscle bulk and strength for peak performance. For astronauts, the absence of gravity removes a lot of the drive to maintain and build muscle that occurs when we just move about on earth and can have devastating consequences if not well managed. It’s ridiculously expensive to provide exercise for astronauts during space travel so the food they are provided must help their muscles to get the most from the time they can exercise.

Researchers have found that the animal proteins they tested helped build more muscle than the plant proteins. Not every protein known to man has been tested but it seems the benefit is a consequence of the amino acids they contain. Of 20 amino acids humans use, most are interchangeable to build whichever protein is needed in the body or brain, but some are ‘essential’, meaning we must get them from the food we eat—no substitution is possible. Of those found in human muscle, leucine seems to be especially important. Proteins with higher leucine content seem to be useful for muscle building when they are eaten close to the time you exercise (ideally within an hour).

There is a list of some foods and their leucine contents in Foodworks.

Building and maintaining muscle is of immense importance to athletes, but even if you are not planning to run a four-minute mile any day soon, your muscles will benefit in the same way.

What about animal protein foods and cholesterol?

Years ago, concerns about fat and cholesterol may have had you eating less meat, eggs and dairy; but those concerns don’t stack up quite the same way at a later age. Protein is now much more important, and the other nutrients those foods supply are a bonus. Low fat diets are no longer what most need.

As you read on you will understand more and more about why it’s time to ditch some of the concerns of your youth and enjoy one of the benefits of reaching a mature age.

3: Providing memory jogs to those forgetful muscles

Like you and me, muscles like to be reminded they’re needed. There’s no getting around the saying, ‘use it or lose it’. Sure, it’s harder to keep your muscles the way they were, but unless you keep using them, and using them well, they’ll forget what they’re there for.

That means you need to think about the type of muscle activity you do. First of all, there’s the benefit of gravity. Our muscles thrive on the effects of gravity and you can use that to your advantage by avoiding sitting or lying down too much. Of course you need to rest, but don’t get complacent: keep looking for ways that gravity can help you every day: get up, stand tall, move around, carry things, use the stairs, park farther from the shop, walk instead of drive, rake the lawn, sweep the floor. There are endless examples. If you happen to enjoy some water-based activity, the action of moving against the water in swimming or aqua aerobics classes also gives your muscles a good reminder, without the impact of gravity.

Then there is exercise itself. Sadly, it’s just not enough any more to stroll around the shops or go for a leisurely walk. In order to boost muscle function at every chance, you need to do activities that stress your muscles and help make up for those absent hormones and vastly diminished nerve triggers. And because you have muscles everywhere, it has to be an activity that works not only your legs, but also your upper body, arms and abdomen. Your muscles need to work against a weight (resistance exercise) to encourage them to build.

Luckily, ‘resistance’ doesn’t have to mean lifting weights in a gym. Walking briskly or uphill, swimming laps or doing aqua aerobics, sweeping or raking the leaves, taking the stairs more often, even doing supervised exercises like tai chi or over 50s fitness classes are all good, as long as they get your heart rate up and have you puffing and sweating a little. See below for a list of suggested activities to maintain your muscles.

All these activities need to be checked with your doctor first and carefully supervised as you get older, but that doesn’t mean you shouldn’t do them. Using age as a reason to do less physical activity, to sit most of the day and have daytime naps, will only do harm in the long run.

As soon as possible after being immobilised or bed ridden due to illness, accident or any other reason, you must work extra hard to help recover any muscle that’s been lost. It may not be what you feel like doing, but immobilisation removes those essential muscle reminders and mustn’t be ignored if you want to return to the activities you enjoy, or you could face ongoing illness and declining health.

Joan and Betty were wrong to believe that what Joan had read in magazines and diet books applied to them, and they were wrong to believe that slowing down and eating less was ‘just a part of getting older’.

The rules about what is good for you now you are older are not the same as when you were younger. If you could count on living only until your late 60s, your muscle reserves might well hold out without much help. However, as you are likely to live well past that age, your health and independence in the future depend on your muscle reserves still being there when you need them in your 80s and beyond. And that won’t happen without you making the effort.

Figure 4: Guidelines for exercise to help maintain muscle function

The ideal is to combine aerobic, resistance, flexibility and balance activities, so you need to find activities you are able to do that don’t put you at risk of falling; and ideally that interest you. Professional assistance is ideal but not essential. Everyday activities like vacuuming and mopping, raking, sweeping, gardening, carrying the shopping and doing housework contribute, but adopting the following are your best bet to cheat ageing:

Aerobic

›On at least 3 days per week initially, increasing to every day

›Aim for 30 to 60 minutes each day, which can be accumulated in 10 minute bouts

›Make at least 20 or 30 minutes of this time at vigorous intensity (puffing and sweating).

Resistance

›Weight training at least 2 days per week

›Do exercises for all major muscle groups: legs, arms, abdomen, hips, back, chest, shoulders

›Use a weight you can just manage for 8–10 repetitions for each muscle group, and when it gets easy to do more than that, increase the weight (more effective than doing extra repetitions).

Flexibility

›Do sustained stretches for each major muscle group on at least 2 days a week

›Use static stretches, don’t ‘bounce’ or use movement during stretches.

Balance

›On at least 1 day a week, working up to every day, do 4 to 10 different balance activities in a safe environment, repeating each 1or 2 times.

Figure 5: Exercise guidelines for recovery after illness or immobilisation

Resistance exercise is the most important for recovery. Don’t expect it to increase the size of your muscles as that’s unlikely, but it will help in your recovery, boost your strength and ability, and improve your longer-term health. You can start with either no weights or very light ones, but add extra when you can, or do extra repetitions on the same weight so you progress in strength.

As soon as you are able—even while you are confined to bed (and as long as it’s safe to do so)—start to do as much as you can even if it’s only one or two activities at first. Work up to doing 8 to 12 repetitions of exercises for each major muscle group: legs, arms, abdomen, hips, back, chest, shoulders.

If you have had surgery or an injury and are in hospital, check what you are able to do with the physiotherapist or ask your doctor.

As soon as you are able to, return to doing all your maintenance activities.

4: The damage done by bed rest: it’s like being in outer space for your muscles.

Being immobilised by illness—also somewhat misleadingly called ‘bed rest’—is more harmful to your muscles than merely leading an inactive life. It affects your body much the same way as being in zero gravity does an astronaut, and it’s worse the older you get. It actively robs you of muscle, which doesn’t come back automatically when you are older.

If you have had an accident, surgery or sickness, chances are you will spend some time in bed, and during that time your muscles won’t get their usual workout. That includes the everyday fight against gravity to keep you upright as well as everything else you do to remind your muscles what they are there for. So, although you may not feel like doing anything more active than eating delightful hospital cuisine and drinking insipid tea while confined to bed, you are going to lose muscle if you don’t get up and do some exercise as soon as you can.

There is a little bit of a silver lining: some of the lost muscle becomes protein reserve and is diverted into repairing wounds, combating infection or fighting off fever. Unfortunately, the combined loss through diversion into repair work and lack of exercise can be large. Realising what’s going on and working to minimise the effects can be your key to stopping a vicious cycle of muscle loss and illness, which could trigger increasing frailty and chronic ill health. Get active as soon as you are able, so that muscle loss won’t become permanent.

To be clear, you might also lose body fat with this type of weight loss, but that’s not the bonus you think it is because weight loss during immobilisation, illness or after surgery is a sign that all-important muscle has also certainly been lost.

If the time in bed is only a day or two it might seem like there’s little to be worried about: it might be unavoidable and you need to enjoy the rest. Research with healthy individuals has shown that 10 days in bed can easily rob you of 1kg of muscle and that is a lot to lose. If you are very unwell (during a serious illness like pneumonia, a major surgery or a pressure injury) that same amount can be lost in just four days and losses will continue as long as you remain immobile. (see figure 6 on muscle loss impacts below)

This is the time for getting good protein and doing everything you can to move as soon as you possibly can. If that’s not possible then you must move on to good rehabilitation including exercise and eating that builds muscle.

Daytime rests can also be an issue if they get out of hand. A ‘nanna nap’, or the ‘40 winks’ often mentioned in my family, can certainly be replenishing, but too much rest time every day just means your muscles are missing out.

Figure 6: How much muscle do I have and how can losing it affect me?

The amount of muscle we have varies enormously depending on our genetics and how much resistance exercise we do regularly. For most moderately active people in the healthy weight range, muscle is usually about 40% of bodyweight.

›Muscle loss increases your chance of gaining excess weight and your likelihood of developing type 2 diabetes or hampering management if you already have diabetes

›During a major illness, losing just 5% of body muscle reduces the function of your internal organs and slows wound healing

›With a loss of around 20% body muscle, organs begin to fail

›Death can result from a 40% body muscle loss.

5: The problem of an over-enthusiastic immune system.

Your immune system is able to rally the ‘protein troops’ to mount a defence almost the instant a foreign substance enters your body. It’s working before you’re even aware you’ve been invaded, and it can neutralise a threat before any symptoms get the chance to appear.

It’s an awesome response plan and it efficiently protects you from illness. Specialised immune substances are made from protein as soon as the system starts up and that continues as long as there is a need. That protein can come from your last meal, but between meals and anytime you are not eating well, it’s muscle protein that is used.

A strong immune system requires balance: too much immune activity can be as damaging as too little. Part of the immune response depends on inflammation, which is important in rallying the body’s defences, but it’s also where too much activity can cause problems. The condition known as chronic inflammation (or what is often known as CLIP—chronic low-grade inflammatory profile—in medical terms) is covered in more detail in Brainworks but needs mention here.

At a later age, the immune system can be slow to switch off after an illness—remaining active longer than is necessary and contributing to chronic inflammation. As a result small amounts of muscle can continue to be lost even when you have recovered or are feeling quite well—often for long periods of time. Sometimes your immune system can react when there is no real threat, and that’s a big problem for your muscles because targeting unwanted invaders, whether real or not uses muscle protein.

You won’t always know that muscle has been lost, although weight loss may be a tell-tale sign. When you are older, you should always assume that you have to actively rebuild your muscle reserves after any illness. The same recovery strategies you put in place after immobilisation will also help head off any lingering losses after illness.

The gut microbiome: protection and impacts on immune response.

You may have read about the amazing influence the billions of bacteria living inside your gastrointestinal tract (or more simply, your gut) have on your mood, behaviour and the health of your brain and that is discussed in detail in Brainworks.

What I’d like to touch on here is the protective role of the gut microbiome. While anything we put in our mouths contains an array of things that are good for us, there are always going to be some that can do us harm. The gut microbiome monitors what’s there, ‘senses’ those that are bad and passes the information on to the gut–brain axis, from where an immune response is coordinated.