Malnutrition and Associated Sarcopenia - Episode 8

Rebuilding Muscle Mass: Protein and HMB

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Peter A. McCullough, MD: Nutritional supplementation, in terms of increasing protein intake and increasing key micronutrient intake, works with the body’s own natural processes. It’s important to realize that the skeletal muscles are a reservoir of amino acids, and the body is always in a process of anabolism, which is building up muscle mass, and catabolism, breaking it down. We need amino acids to build and rebuild other proteins, including important carrier proteins in the blood, albumin, and important immune proteins, including globulins, as well as a whole array of signaling peptides in the human body. So, as we increase protein intake—and specifically, amino acid protein intake—we provide a framework for the body to re-establish healthy functions in terms of not only muscle mass in function, strength, immunity, and cell signaling, but in overall health of the human body, including the heart, lungs, bones, and other solid organs.

Nicolaas Deutz, MD, PhD: One can think about how can it be that protein intake helps to reduce muscle loss. From the scientific point of view, the way we look at it is as follows: if the body does not have enough amino acids that are the basis of the protein, then it needs to come from somewhere. If you normally give protein within the meal, then that is the source of the amino acids. But if you do not give enough protein, the body still wants all those amino acids for the metabolism, and the only way to get it is to actually break down other organs. Muscle is, by far, the biggest component in the body, so then it starts to use muscle protein, by that muscle tissue. Protein is actually a way to give the body sufficient nutrients, so it does not need to break down muscle tissue. A good example is actually a pregnant woman. If the baby needs nutrients, it will take nutrients. So, if the woman does not take enough food with them, it will also start to break down muscle tissue. It’s exactly the same system. What we do in nutrition is actually provide sufficient nutrients so that it’s not necessary for the body to break down muscle tissue.

When older adults need nutritional supplements, we usually focus on increasing their protein intake. But recent research that we’ve done, and others, have shown that there is one other component that can be added to the nutritional supplement, and that component’s name is HMB (beta-methyl, beta-hydroxy methyl butyrate). This is a product that is known for many years in the body builders. They know that they have to take HMB to grow their muscle mass. And how this has been used is to see whether we can stop muscle loss in older adults. A recent study that I published, putting older adults into bed for 10 days, showed that by adding HMB in their nutrition, it actually could stop their muscle loss. So, HMB is a very interesting component, and it is a natural component because it’s produced in the body on a daily basis from another amino acid, leucine, which is part of protein. Indirectly, by giving protein, you also increase the production of HMB in the body—but not enough. You have to add it to a nutritional supplement. It’s a very interesting component that really can make nutritional supplements more efficient. In my personal view, it’s very efficient when people are not able to take enough protein. So, by adding the HMB to a nutritional supplement, even if the person doesn’t take enough protein, makes the supplement more efficient. This is very important for older adults because they’re having a hard time and have to drink supplements instead of food.

Peter A. McCullough, MD: The nutrition community has become aware, over the last several years, of an important nutrient called beta-methyl, beta-hydroxy methyl butyrate, or HMB. HMB has been used as a supplement to build muscle in athletes safely for many years. We know that a dose of about 3 to 4.5 g/day will not only maintain muscle mass, but will improve muscle mass. HMB is contained in trace quantities in avocado, grapefruit, and some other food stores. But in fact, through diet, one could never consume enough of these types of foods to get a therapeutic dose of HMB.

HMB has now gone through sufficient randomized clinical trials where it shows it clearly increased lean muscle mass. It retards against the progressive loss of lean muscle mass in a setting of chronic disease. And in a recent randomized trial of receiving a supplement, where patients received approximately 3 g of HMB per day—the NOURISH trial versus conventional food diets—patients with chronic illness hospitalized [and] then followed into the outpatient setting had a reduction in mortality.

And it’s rare that we see any reductions in mortality across these broad conditions after hospitalization, but a statistically significant reduction in mortality. And the chain of logic is that if a patient was on HMB supplementation with Ensure Enlive, in fact, they had a better nutritional status, a greater lean muscle mass, and less loss of lean tissue and muscle after intercurrent illness. And so, it made them more robust or more survivable to the next event. And the next event could have been a fall, a fracture, an infectious complication, or just a decompensation of the base illness. In fact, they were more resilient to the lethal effect of subsequent events over time.