The sick aging phenotype

Phat Phil

The discussion that follows is derived from my personal fitness bible, The Barbell Prescription, written by Dr. Jonathon Sullivan and Andy Baker.

Sullivan runs a business known as Greysteel and he specializes in strength training for middle aged folks and the elderly.

Andy Baker is a well known strength trainer.

Be sure to check out both of their websites.

So, what is the Sick Aging Phenotype?

It refers to individuals who are dealing with a combination of metabolic syndrome, muscle and bone loss, frailty, loss of independence, and who are reliant upon a pile of pharmaceuticals just so they can wake up another day.

The result is declining health over time and a poor quality of life as they age, particularly at the end stages of life.

Wellness Will and Phat Phil

Sullivan and Baker compare fictitious twin brothers… Wellness Will and Phat Phil, who are now in their mid-50s.

They have the same genes, but they pursued different lifestyles.

Will is an avid sportsman who loves hiking, fishing and hunting. He also trains at the gym regularly, and eats a diet rich in protein, veggies and fruits.

Will still deals with a little bit of arthritis, but the only medications he takes are a daily aspirin and occasional acetaminophen for pain.

Will is strong, weighs a solid 210 pounds and has 17% body fat.

Wellness Will (ok, not Phil’s twin!)

Barring a tragic accident, Will will likely die from a sudden hemorrhagic stroke in his late 80’s while hiking with his much younger girlfriend.

In our society today, Will is the rare Fit Phenotype.

Phat Phil went the other direction.

He smokes, drinks and spends most of his free time sitting in front of his big screen TV consuming a steady diet of pizza, Dorito’s and Pepsi.

Phil’s body fat is 48% and he is pushing 300 pounds. He doesn’t like visiting doctors for regular checkups, but is often in the ER for one ailment or another.

He has Type II diabetes and high blood pressure.

Three years from now, Phil will drop dead of a massive heart attack.

Metabolic Syndrome

According to Sullivan and Baker, metabolic syndrome is a key driver of unhealthy aging in the developed world.

Metabolic syndrome is characterized by significant visceral obesity (fat accumulation around the internal organs), insulin resistance, high blood pressure, issues with cholesterol levels and triglycerides, and inflammation.

How does this occur?

Development of metabolic syndrome is complex, but much of the research points to obesity as playing a role.

Not all big people have metabolic syndrome.

Some big people can carry around some fat even though they are active. They still look healthy. Genetics can play a role.

However, if a poor lifestyle is the cause of obesity, then it is more likely going to be associated with metabolic syndrome.

Sarcopenia and Ostopenia

Frail

They loss of muscle mass (sarcopenia) and bone density (ostopenia) are not caused by metabolic syndrome, but they often accompany it.

The onset of sarcopenia begins around age 40 for people who lead a sedentary lifestyle.

This loss of muscle mass can compound metabolic syndrome if it accompanies obesity.

The progression Phat Phil’s sedentary lifestyle to metabolic syndrome then leads to even more loss of muscle mass and a decline in insulin sensitivity.

“Unused, detrained muscle downregulates insulin receptors turns off protein synthesis, and begins to eat itself to provide calories and amino acids to the rest of the body, which because of the decreased insulin signaling, thinks it’s hungry.”

The result is loss of muscle and strength.

Other tissues, such as tendons, ligaments and cartilage experience adverse effects due to the decline in activity.

Even nerve tissue can undergo progressive deterioration in aging, and declines in insulin sensitivity are at least partly responsible for brain atrophy and dementia.

Over time, Phat Phil becomes more frail and reliant on pharmaceuticals to deal with all of his accumulating issues…

Insulin for diabetes
Metformin for diabetes
Medications for hypertension (high blood pressure)
Vicodin for chronic pain
Zantac for chronic stomach issues
Baby aspirin for coronary artery disease
Albuterol for COPD
Depression and anxiety meds
Clopidogrel for coronary artery disease
Etc.

The end game is that Phil has a massive coronary, and isn’t strong enough to survive because his obesity, diabetes, high blood pressure and poor circulation lead to too many complications.

Phil ultimately dies because he has inadequate physiological reserve.

Choices

Phil’s story sounds extreme, but it is actually quite common.

The reality is, he may have been blessed to die in his 50s.

Genetics will play a role in how long some people can survive with this lifestyle.

However, they will still suffer from weakness, constant illness and frailty, and will ultimately lose their independence.

So, what do you want to do?

Roll the dice with Phat Phil’s lifestyle and maybe make it into your 80s, but not really enjoy life?

Or, do the hard things to live a full, healthy, active and high quality of life?

I choose the latter.

I don’t train so I can live to 100. I train just in case I do, and so I can stay active doing the things I want between now and then.

If you are around my age (late 50s) or maybe up to 70, and have been heading down Phat Phil’s path, you still have time to turn things around.