Do you even need BCAAs Bro?

If you’ve paid any attention to the pendulum swing of supplements for muscle and performance, you have likely become dizzy (our recommendations go back and forth and back and forth) and are still left wondering how to consider supplementation in your aging patients. 

With most performance-based research on collegiate athletes, it’s always been difficult to understand if we should borrow studies on muscle mass and strength for our aging patients with sarcopenia. Patients in the peak of their athletic years, who have reached peak hormone production and follow regimented training regimes, often fail to benefit from additional supplementation of protein or amino acids. Performance-based supplements usually achieve fractional improvements in outcomes, which rarely translate to a weekend warrior patient or recreational athlete.

But never should we assume that a young, 21-year-old man will respond similarly to an intervention as a 60-year-old patient. For a health metric (muscle mass) that requires both nutritional foundations and physical stimulus, comparing these two individuals is not only useless but may also deny our aging patient the opportunity to be better supported against age-related sarcopenia. 

In the last 5 years, multiple studies have been published on protein intake [1,2], leucine/HMB [3–7], fish oil [8–11] and creatine [12,13] for aging muscle. Contrary to studies in younger populations, patients with established sarcopenia or who are at risk of disuse atrophy are generally positive. Especially in populations with low baseline protein intake and who are initiating resistance training programs for the first time. 

Based on the current literature, when clinicians have high suspicion of sarcopenia or patients are at risk of disuse atrophy due to surgery or other reasons, we recommend the following based on the current literature: 

• Assess baseline nutrition status and adjust protein intake to 1.2 grams per kilogram per day. 
• Consider leucine or HMB supplementation in patients who have baseline low protein intake until patients reliably consume adequate protein based on their ideal bodyweight. 
• Fish oil supplementation, especially in patients with disuse atrophy or low baseline protein intake at baseline. Fish oil appears to work by mechanisms other than anti-inflammatory effects. 
• Creatine supplementation 

The next time you see a claim that any or all of these interventions are ineffective for improving muscle mass or strength, ask the important question: 

They don’t work for whom? 

Baseline status impacts outcomes in muscle literature significantly. Aging patients have improvement in muscle function and may have improvement in muscle mass with interventions that don’t work in younger populations. Individualize your approach by asking who the intervention is for, what their baseline intake is, and what you’re trying to achieve.