Editor’s note: This article is the final installment in a three-part series. Parts one and two discussed the interconnected relationships between muscles, joints and bones. And, using a three-legged stool analogy, the articles explained that while the bone and joint health categories are strong and well-established, the muscle health category is the natural products industry’s weakest leg, offering brands tremendous growth potential.
The muscle health category addresses a far greater—and more serious—need than sports nutrition or even active lifestyle. Age-related muscle loss affects 100% of the population. The main target market is every general consumer between the ages of 35 and 65 who wants to maintain the muscle mass and function they currently have.
For the most part, the industry is completely overlooking this much bigger market. A mindset shift may be needed to start thinking about the muscle health category in terms of:
• Obesity and metabolism. Age-related muscle loss slows metabolism, impacting the body’s ability to burn calories and confounding weight loss efforts. Conversely, people with plenty of muscle even burn calories as they sleep.
• Building reserve muscle capacity to avoid the disability threshold. Consider this scenario: Jane is hospitalized for a week. Despite being in bed all that time, she has no problem walking once she’s released. Mary is also hospitalized for a week. But when she’s released, she’s weak and unstable. She’s become a fall risk. Without adequate muscle capacity reserves, her hospitalization has pushed her over the disability threshold.
• Quality of life. People can have strong bones and a full range of motion with minimal joint discomfort, but those aren’t much help if they don’t have the muscle strength to get out of a chair. Consider those who can no longer carry their groceries from the garage to the kitchen. Those whose balance is compromised due to weakened hip and thigh muscles. Those who can no longer safely walk to the bathroom by themselves. Those whose muscle loss has led to them becoming frail or even bedridden.
More can and should be done than writing prescriptions for physical therapy and encouraging patients to consume protein drinks.
Muscle health ingredients sparse
Of course, protein is important. This macronutrient plays an essential role in building muscle. But protein synthesis is a crowded space … and muscle-building is only part of the equation. The other side—the one not getting the industry attention it deserves—is attenuating muscle loss.
As physicians, we are emphasizing the importance of making sure the muscle machinery is well balanced: The switches that build (anabolic) are on, and the switches that tear down (catabolic) are minimized. Ideally, one wants to go from net negative muscle loss to net neutral or net positive.
To gain muscle reserves, exercise is not always the complete answer. People often lack the necessary commitment and motivation. Just compare the crowded gyms in January with the sparse attendance after mid-February. Other consumers may be too frail to exercise or have different limitations.
Research suggests creatine1 and leucine2 may help trigger muscle strength and protein synthesis. Alternately, calcium beta-hydroxy-beta-methylbutyrate (also known as hydroxymethylbutyrate [HMB]) uniquely stimulates both protein synthesis and reduces muscle breakdown.3 It helps to keep the muscle machinery in balance.
At this writing, only the combination of HMB plus vitamin D3 had been shown in NIH-funded research to improve muscle function in older adults, with and without exercise.4
In some countries, we are starting to see companies going after the total musculoskeletal health maintenance category with bone/joint/muscle formulas that include collagen, vitamin D and HMB.
From an industry standpoint, this area of muscle health is still a newer category. But muscle synthesis and degradation are well-researched from the medical and sports nutrition perspectives, as well as for animal-based food production. No ignorance exists in the science concerning what makes muscles bigger and stronger.
Personalized nutrition has also been discussed. Just as some genes are responsible for muscle growth, a whole family of genes and processes are also involved with breaking down muscle. While probably not soon, we fully expect researchers to start investigating these different gene pathways and how they may be affected by dietary supplementation.
Fueling the muscle health category
The real expansion will be accomplished through ongoing research and by educating consumers about those validated ingredients already showing clinical relevance such as HMB, vitamin D, creatine, leucine or other well-studied sports nutrition ingredients that have applications in the general population.
As an industry, we need to make people aware of the value of nutritional intervention for balanced muscle regulation. We need to create desire among consumers by teaching them about the importance of protein as well as its limitations. Overconsuming protein won’t solve grandma’s inability to climb a flight of stairs any more than just drinking milk will fix osteoporosis.
Supplement manufacturers and raw materials suppliers should demand scientific evidence. In the joint health category, countless human clinical studies have been done on glucosamine/chondroitin. Dozens of finished joint health products are backed by at least one human clinical study. We want to expand in this area for muscle health.
Until the unbiased scientific community becomes aware of where they should be looking, they won’t be researching. So, by and large, it’s currently up to ingredient suppliers and supplement manufacturers to privately fund and conduct the research needed to drive science forward and show viable proof of concept.
Once a certain threshold is reached, others will want to study it. When third-party people in the scientific community start to show interest, such as the NIH grant to study HMB, that’s when things will start to explode.
And that’s the level of curiosity and excitement we want to drive.
Naji Abumrad, M.D., (“Dr. Naji”) is an award-winning educator, board-certified surgeon, National Institutes of Health (NIH)-funded researcher, and fellow in the American Association for the Advancement of Science (AAAS).
Jason Theodosakis, M.D., (“Dr. Theo”) is a board-certified physician, bestselling author, researcher, consultant, lecturer and fellow in preventive medicine. He has a second medical specialty (sports medicine), along with master's degrees in both exercise physiology and public health. For more information, visit the Dr. Theo website.
1 Kreider RB et al. “International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine.” J Int Soc Sports Nutr. 2017;14:18.
2 Trabal J et al. “Effects of free leucine supplementation and resistance training on muscle strength and functional status in older adults: a randomized controlled trial.” Clin Interv Aging. 2015;10:713-723.
3 Wilson GJ et al. “Effects of beta-hydroxy-beta-methylbutyrate (HMB) on exercise performance and body composition across varying levels of age, sex, and training experience: A review.” Nutr Metab (Lond). 2008;5:1.
4 Rathmacher JA et al. “Long-term Effects of Calcium β-Hydroxy-β-Methylbutyrate and Vitamin D3 Supplementation on Muscular Function in Older Adults With and Without Resistance Training: A Randomized, Double-blind, Controlled Study.” J Gerontol A Biol Sci Med Sci. 2020;75(11):2089-2097.