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Health Protocols

Catabolic Wasting - Cachexia and Sarcopenia

Loss of muscle and fat tissue due to illness is called cachexia. The general loss of muscle mass that occurs with advancing age is called sarcopenia. In both cachexia and sarcopenia, muscle loss can lead to frailty and declining quality of life, as well as increased risk of death, infection, and falls; slower wound healing; and reduced exercise capacity. The term “catabolic wasting” encompasses both cachexia and sarcopenia.

A number of nutritional interventions may be useful to prevent and treat catabolic wasting, including whey protein, creatine, and the amino acids glutamine, arginine, and HMB (hydroxy-methylbutyrate) (a leucine derivative).

Symptoms and Diagnosis

  • Weakness, fatigue, and difficulties in daily living
  • May be difficult to distinguish between cachexia and sarcopenia; aging individuals may experience both simultaneously.
  • Moderate-to-severe cachexia or sarcopenia can be diagnosed by observing loss of muscle mass, strength, and tone.

Some researchers have proposed that cachexia and sarcopenia should be diagnosed by calculating lean and fat body mass by imaging techniques such as MRI (magnetic resonance imaging).

Risk Factors


  • Chronic diseases, such as cancer, AIDS, heart failure, chronic lung disease, and inflammatory bowel disease


  • Aging
  • Malnutrition
  • Physical inactivity
  • Heart and/or kidney failure
  • Type 2 diabetes

Conventional Treatment

  • Encourage food and fluid intake and drug treatment, including DHEA, growth hormone, and cannabinoids.
  • It is important to receive proper treatment for the underlying cause of the cachexia.
  • A number of studies have reported that testosterone treatment has been useful in promoting lean weight gain for people with AIDS- or COPD-related cachexia, and can improve protein synthesis and muscle mass in men and women.

Note: Aging individuals who notice their muscle mass begin to decline should have their hormones tested at least once a year. More information is available in the Male and Female Hormone Restoration protocols.

Novel and Emerging Treatments

  • A double-blind study in healthy postmenopausal women reported that a single dose of an experimental drug that inhibits myostatin activity (a protein that limits muscle growth) produced a 5.1% increase in thigh muscle volume compared with a 0.2% reduction with placebo.
  • Beta-adrenergic drugs like formoterol, selective androgen receptors modulators (SARMs) like the investigational drug enobosarm, and the investigational anti-cancer drug selumetinib also increase lean muscle mass.
  • A number of human studies have reported that treatment with ghrelin, a hormone produced in the gut that functions in the central nervous system, is associated with increased appetite, muscle and fat mass, and functional status in people with sarcopenia, cancer, COPD, and end stage renal disease.

Dietary and Lifestyle Considerations

  • Exercise, especially resistance training (eg, lifting weights), is critical for maintaining muscle mass in those with cachexia and sarcopenia, and is most effective when coupled with proper nutrition.
  • Consume adequate protein and amino acids.
  • Avoid smoking.

Integrative Interventions

  • Whey protein: Whey provides has an excellent amino acid profile; it is a rich source of many amino acids vital for muscle building, including the branched chain amino acids leucine, isoleucine, and valine.
  • Creatine: Daily supplementation with creatine has been shown to increase muscle strength and endurance in the elderly while performing daily activities.
  • Amino acids: Leucine’s derivative HMB, along with the amino acids glutamine and arginine, play key roles in treating muscle wasting.
  • L-carnitine: Several published studies have reported that many patients with cancer-related cachexia are often low in carnitine, and daily supplementation is associated with reduced fatigue and increased lean body mass.
  • Omega-3 fatty acids: A British study of older adults reported that consuming higher levels of fatty fish was associated with greater handgrip strength, which is a marker of muscle function.