BCAA supplementation may improve Sarcopenia and reduce risk of liver toxicity; serendipitous Nestle Ed webinar,

'Hot Topic 2023: Contemporary Nutrition Issues', Nestle Medical Hub.

Sarcopenia is muscle wasting that occurs with aging and other conditions of illness and infirmity - needing to recover would worsen the tendency. We lose muscle more easily as we age and have a harder time making new muscle tissue. The problem with this besides weakness, and increased risk of falling or dropping things, is that muscle tissue helps us detoxify ammonia. When we have less muscle, we are more likely to burden the liver with ammonia - or when we have liver damage, then our muscle mass is our backup plan for ammonia detox.

• Protein and Branch Chain Amino Acids were discussed briefly in the last post: Protein adequacy is critical for preventing infection or chronic inflammation. (denutrients.substack.com).

• BCAA include valine, leucine and isoleucine. Their molecular structure includes a branching shape. They are considered essential amino acids and extra may be helpful for liver support.

Chronic liver disease is a condition where extra Branch Chain Amino Acids may be recommended, but why exactly is not well understood. Supplements of BCAA may be helping the liver condition by helping improve muscle mass — which would help detoxify ammonia:

“Branched-chain amino acids (BCAA) are used as a therapeutic nutritional supplement in patients with cirrhosis and hepatic encephalopathy (HE). During liver disease, the decreased capacity for urea synthesis and porto-systemic shunting reduce the hepatic clearance of ammonia and skeletal muscle may become the main alternative organ for ammonia detoxification. […]

Plasma levels of BCAA are lower and muscle uptake of BCAA seems to be higher in patients with cirrhosis and hyperammonemia. BCAA metabolism may improve muscle net ammonia removal by supplying carbon skeletons for formation of alfa-ketoglutarate that combines with two ammonia molecules to become glutamine. An oral dose of BCAA enhances muscle ammonia metabolism but also transiently increases the arterial ammonia concentration, likely due to extramuscular metabolism of glutamine. We, therefore, speculate that the beneficial effect of long term intake of BCAA on HE demonstrated in clinical studies may be related to an improved muscle mass and nutritional status rather than to an ammonia lowering effect of BCAA themselves.” (Dam, Ott, Aagaard, Vilstrup, 2013)

Slides from the webinar, Hot Topics 2023: Contemporary Nutrition Issues, (nestlemedicalhub.com) regarding calculations or other assessment tools for nutrient recommendations for high need/critical patients with hepatic encephalopathy as the speaker’s focus, Puneeta Tandon, MD, MSc. She makes a strong case for better screening and referral to dietitians for patients with chronic liver disease. They would be helped to have a focus on reducing frailty and muscle loss (sarcopenia) and improving any other malnutrition issues. Improved muscle mass would help support detoxification which the liver is no longer handling as well with disease dysfunction.

Slide by Puneeta Tandon, MD, MSc, for Hot Topics 2023: Contemporary Nutrition Issues, (nestlemedicalhub.com).

Slide by Puneeta Tandon, MD, MSc, for Hot Topics 2023: Contemporary Nutrition Issues, (nestlemedicalhub.com).

The first speaker, Puneeta Tandon, MD, MSc, goes on to emphasize that timing of protein and meals counts - early am breakfast and evening snack are important to prevent reduced levels of glycogen in the liver - eat every 3-4 hours is recommended during the day. Muscle mass is better preserved in their patients who eat more frequently and prevent longer periods of starvation in the liver and muscles.

Preventing frailty helps reduce mortality and morbidity - level of unwellness in patients. Frailty includes muscle loss from sarcopenia, reduced exercise leading to more risk of falls or greater immobility.

That was just the first few minutes of an hour and a half continuing education webinar for dietitians and other diet/nutrition professionals. The site requires registration, but this session has an unlisted Youtube link.

So exciting - sarcopenia in inflammatory bowel disease is up next. Exciting for dietitians and IBD patients maybe.

The thing about prevention is building good health habits that help prevent becoming a liver or IBD patient. Sarcopenia is common with aging but staying active and eating a plentiful amount of protein at breakfast in addition to lunch and dinner can help prevent it from happening. I also have been taking DHEA supplements since age 35. We all start making less around that age and it is a hormone that helps support our ability to repair or build new muscle tissue.

The ‘adequate’ protein at breakfast is more than the standard American breakfast contains unless you eat the two eggs and a breakfast meat style meal. Cereal, toast, pancakes, fruit, granola, all are not going to add much protein and do add a lot of carbohydrates. The goal is 20-30 grams of protein at breakfast, lunch and dinner. That isn’t easy on a bean diet as a 1/2 cup of beans is only 7-9 grams of protein - eating a full 1 1/2 cups of beans would be a lot of beans with nothing else and packs a lot of carbohydrate calories. Using some nuts and seeds has minimal carbohydrates and more fat but may be harder to digest for some people. An egg or ounce of meat is considered to provide ~ 7 grams of protein on average, varied amounts of fat and no carbs.

I have been eating too much lately, since my own health scare when my panicked use of nitroglycerin that I didn’t need left me vomiting for a full day. I was so thin after that, it just wasn’t me, didn’t seem right. Now I have a little extra menopausal pudge that also doesn’t seem like ‘me’ (pre-menopausal me) and which I don’t like but ‘frailty’ - yes, I was too skinny at that time. My digestive system seems better now and I have been doing some yard work. Since passive exposure, 2021, I have to be careful not to over-exert or I go into relapse/autoimmune like. We make myokines from muscle activity, so working hard can leave us in a cytokine storm like recovery period from the myokines. Eating polyphenol rich foods before or after the exercise can help the body cope with the increase in inflammatory signaling chemicals.

To test for sarcopenia handgrip strength is assessed, walking/gait is observed, and standing on one leg might be checked - how strong is a person and is their balance good or a fall risk?

Post:

Standing on one leg - a life lengthening skill.

Really old post - edematous malnutrition is likely due to lack of protein while plenty of carbohydrates are available and there may be a deficiency in N-acetylglucosamine (NAG) which is found in insects and the shells of shellfish, but is not the same exact chemical as the glucosamine sold for joint pain:

Alp Luachra, an old name for edematous malnutrition

Disclaimer: This information is being shared for educational purposes within the guidelines of Fair Use and is not intended to provide individual health guidance.

Reference List

(Dam, Ott, Aagaard, Vilstrup, 2013) Dam G, Ott P, Aagaard NK, Vilstrup H. Branched-chain amino acids and muscle ammonia detoxification in cirrhosis. Metab Brain Dis. 2013 Jun;28(2):217-20. doi: 10.1007/s11011-013-9377-3. Epub 2013 Jan 15. PMID: 23315357. https://pubmed.ncbi.nlm.nih.gov/23315357/