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Drug shortages, Eye drops for myopia, Is muscle more dense than fat? Sarcopenia

Dr Mark Porter finds out why some common drugs are in short supply, how atropine may help children with myopia, if muscle is more dense than fat and about muscle loss in middle age

An unprecedented number of medicines are in short supply, according to NHS England. Doctors, pharmacists and patients all over the UK are finding common drugs like naproxen are more difficult to get hold of. Why is there such a problem with supply of medicines that are normally cheap and easy to get hold of? And why a 'severe shortage protocol' due in the next few weeks should give pharmacists more power help ease the situation. Mark talks to Ash Soni, president of the Royal Pharmaceutical Society and pharmacist, Ben Merriman to find out more.
The number of children with short-sightedness, myopia has doubled in the last 50 years. Mark finds out why atropine eye drops, which are widely used in China and Singapore, are being trialled on children in the UK to help prevent the progression of myopia. Professor Augusto Azuara-Blanco from Queens University Belfast explains.
And is muscle more dense than fat? Jason Gill, professor of cardio metabolic health at the University of Glasgow discusses how even a small amount of fat loss can have hugely significant health benefits. Elaine Dennison, professor of Musculoskeletal Epidemiology at the University of Southampton explains why muscle is an under researched part of the body and how we lose muscle mass and strength in middle age and what we can do to prevent it.

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Programme Transcript - Inside Health

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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT.  BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

 

 

INSIDE HEALTH – Programme 2.

 

TX:  15.01.19  2100–2130

 

PRESENTER:  MARK PORTER

 

PRODUCER:  PAMELA RUTHERFORD

 

 

Porter

Hello.  Coming up in the next half hour:  Muscles – why we should all be doing more to stay strong.  And treating short-sightedness with eye drops – commonplace in some parts of the world, but not here in the UK.

 

But we start with medicines or rather a lack of them.  Millions of people prescribed run-of-the-mill drugs for conditions like arthritis and high blood pressure are finding that their pharmacy can’t supply their usual pills.

 

Margaret McCartney is in our Glasgow studio.  What is the situation like in Scotland Margaret?

 

McCartney

Well I think it’s just as bad, I mean NHS England have said that there is an unprecedented number of medicines in short supply and I don’t see anything different happening up here.  It is a complete nightmare.  So, you’re busy, you expect to be busy when you’re on call, you know, you expect, when you’re duty doctor, to have a lot of stuff to do and that’s great if it’s stuff that’s really useful for patients but what you’re finding, actually, is it’s just trying to find standard medications that should be in stock and we’re not able to get hold of.  It’s a hassle for us, it’s a hassle for the patients, it’s a hassle for the pharmacists, it’s completely pointless because this really should be sorted out centrally.  And it means that we’re not getting to do more important work because we’re doing this hasslely stuff instead.

 

Porter

To be clear, it’s not generally a risk to patient’s health, this is about the hassle of the patient having to come back and see you and get another drug prescribed, you having to prescribe it?

 

McCartney

Yeah and quite often it’s just to do with dosages or strength or preparation or a different generic brand, for example.  We talked about shortages of epi-pens, adrenaline auto-injectors, last year on Inside Health and that’s a good example of one that was, I think, slightly more frightening to be running out of, I think the supply problems for that have more or less sorted themselves out.  But this is like common or garden stuff, things like naproxen, epilepsy drugs, HRT – stuff that really is basic core medicine, nothing fancy.

 

Porter

Well Ben Merriman is a pharmacist working in a GP surgery in South Cumbria.

 

Merriman

It’s always been an issue, getting hold of certain things but for the last 18 months it has been increasingly troublesome.

 

Porter

Do you remember ever being this much of a problem?

 

Merriman

I’ve been qualified for 12 and a half years and this last 12 months has been the worst I can recall. 

 

Porter

Yeah, well I’ve been in the business a bit longer than that and I think it’s the worst 12 months I can recall as well.  What sort of drugs are we talking about?

 

Merriman

We’re talking about really kind of basic common medicines, medicines for blood pressure like Losartan and Ramipril, really basic things to help people healthy.  There’s a few medicines for epilepsy quite worrying – things like lamotrigine or sodium valproates, some epileptics may take to control seizures.  We have medicines to help with joint pain, so things like alopurinol for gout or naproxen as an anti-inflammatory.

 

Porter

But what about common drugs like, I mean, furosemide, which is a water tablet, a diuretic, I mean these are commonly available, generally, cheap as chips medicines, I’ve never given it a second thought that people wouldn’t be able to get a drug like that?

 

Merriman

Yeah, I mean furosemide to a pharmacist or a GP is like paracetamol or aspirin to a patient, it’s stuff that you kind of don’t even think about as being unavailable, it’s unthinkable that we’re unable to get hold of this sort of medicine.  And unfortunately, it’s really causing – not only is it causing stress for the likes of myself and for yourself, telling a patient – I’m sorry, I cannot get the medicine that you need to keep you well, it is of course causing an awful lot of stress, an awful lot of anxiety which nobody really wants patients to experience.

 

Porter

Now normally we can – in most cases – prescribe a suitable alternative and I presume that’s part of your role, I mean it’s certainly something – we don’t have a pharmacist in my practice so the doctors are doing it – but is that something you’re doing and how much of your time is it taking up?

 

Merriman

Yeah, I mean this is actually kind of forming an essential part of my day, I would spend maybe half an hour to an hour each and every day dealing with this sort of problem – we can’t get hold of drug X right this patient has got this condition, what other medicines can they have?  It’s not something that’s particularly bothersome for me but it does take an awful lot of time and it’s time that I could be spending with patients, helping improve their health.

 

Porter

Now many of these drugs are one or two pounds for a month’s supply, aren’t they, that’s the sort of money we’re talking about?

 

Merriman

Absolutely, yeah, we’re talking a few pence for a tablet, if that.  Unfortunately, what’s happening is because we’re seeing shortages of certain medicines, unfortunately, market forces apply to pharmaceuticals, in the same way they apply to anything else – so if there’s a sudden shortage in the market then all of a sudden, we could be paying four or five pounds for something where we normally pay 40 or 50pence.   And ultimately, it’s the NHS that has to pay for this.

 

Porter

Being Inside Health, we are, of course, very cynical, I mean is there any market manipulation going on, do you get a sense that somebody somewhere is playing foul here by restricting supply to bump prices up, could that be an issue?

 

Merriman

I’ve nothing in concrete to say that is what is happening but there was an example that I came across in March of last year, regarding a drug called bicalutamide, it’s a drug to help – kind of keep on top of prostate cancer – and this drug had been unavailable for about three or four months and then all of a sudden my pharmacy received some of these and just out of interest I checked the expiry date and they expired in April 2019, which meant that they had 13 months of life left.  Out of interest I googled the manufacturer and they’re meant to last for three years from the date they are made.  So, essentially, this product has presumably been sitting on a shelf somewhere for the past 23 months.  Is somebody playing the system here?  Is there any stockpiling going on to lead to shortages to then create artificially high prices?  I don’t know.

 

Porter

And Ben is far from alone.  Ash Soni is a community pharmacist and President of the Royal Pharmaceutical Society. I asked him if he’s struggling with supplies.

 

Soni

Completely, when I’m in my pharmacy I see exactly the same thing – same drugs, same issues, same problems – and actually it’s that bit that Ben highlighted about the patient, being able to turn round to them and say – having to turn round to them and say – I’m really sorry, I can’t get hold of your medication at the moment. 

 

Porter

Because the price difference is huge, I mean talking naproxen, this common anti-inflammatory, what would you have paid for that normally?

 

Soni

Oh normally, historically, naproxen 250 about 80p…

 

Porter

For a month’s supply?

 

Soni

…for a month’s supply.

 

Porter

And what’s it now?

 

Soni

I bought it on Friday at £6.49 a box.

 

Porter

And it’s the same drug, same production costs.

 

Soni

Absolutely, nothing’s changed, apart from the fact of the price I’m paying.  And therefore, potentially, the NHS is paying.

 

Porter

Okay, let’s ignore stockpiling and market manipulation for a moment, what other factors might be responsible?  Everyone talks about Brexit, let’s deal with that first of all.

 

Soni

So, Brexit is an interesting play in this, it isn’t there at the moment, we’re too early.  If you think about the fact that Brexit is two months away, for people to be stockpiling for that length of time they are going to be holding stock for a long time and even for the big companies that’s a lot of challenge.

 

Porter

So, what’s at play then?

 

Soni

So, there are a number of factors.  The first is, potentially, there is some market manipulation going on but I think that’s quite a small piece of this because actually in a way you’ve got to have a shortage – enough of a shortage to be able to create that.  We know there are certain laboratories that are currently closed, the HMRA closed down one supplier 18 months ago now, and they haven’t been able to reopen their factories yet, that’s going to automatically create a shortage because they were producing quite a lot.  You’ve got the fact that the global market is growing, we’ve got the developing world is developing and as a result there are greater demands for drugs from there.  You start taking India, China, Brazil, Russia into account and take their populations into account, that’s not just a small growth it’s huge.  And then from a market perspective, if I’m the manufacturer of a product and you turn round to me and say, well actually if I sell it to Germany they’re going to pay me a fiver, if I sell it to the UK it’s going to be a £1, where am I going to sell it, I’m a global company and I’ve got the same issue?

 

Porter

Is that a major issue here in the UK that there’s so much pressure on prices that we’re expecting people to have drugs that cost 80p for a month’s supply that actually the manufacturers are – it’s too low, there isn’t enough meat on the bone for them?

 

Soni

Absolutely, there is no doubt, whatsoever, that’s happening.  If – in fact to the point where I had a conversation with Teva, because I have a particular patient that takes…

 

Porter

Who are big manufacturers.

 

Soni

Big manufacturer, massive manufacturer globally.  And they make a product called lamotrigine, which Ben referred to, and there’s a shortage of that.  Teva have just discontinued it because it didn’t make economic sense for them to continue to make it.  Well, that’s the type of thing, again, that’s suddenly created more shortages in the market because if you can’t manufacture a price which is going to justify delivering it then you’re not going to manufacture it.

 

Porter

The current situation is we’ve got patients wasting their time going back and forth to the pharmacy, we’ve got pharmacists wasting their time dealing with the patients, we’ve got doctors, like me, having to rewrite prescriptions.  What’s going to change, this has got to change, hasn’t it, it can’t carry on like it is?

 

Soni

Well one way or another we’ve got to find different ways to be able to deal with that.  And the thing that strikes me is that one of the things that we’ve got potentially coming into effect is the Serious Shortages Protocol.  Now this isn’t what this was designed for, this is designed for Brexit.  What it does, it empowers pharmacists to make the changes that currently we’re having to send that patient back to the doctor and the doctor having to make the change on the prescription and then the patient having to bring the prescription back and then me being able to give what I’ve got.  And by the time they come back, on occasions, we’ve run out of that as well.  We’ve had that happen.  But this – effectively this protocol very clearly defines at national level what changes can but also what cannot be made.  So, I know there have been some issues round anti-epileptic drugs and people worried about – oh well, the pharmacist will just change my anti-epilepsy drugs – no, it’s very clear those type of drugs will not be changed without the authority of the prescriber because you’ve got the history and the knowledge about the drugs that patient may have taken before.

 

Porter

And the idea is this makes it quicker and simpler, that somebody comes with a prescription from me, you can give what you’ve got in stock effectively?

 

Soni

Absolutely, it’s very much about that.  So, take naproxen as an example, we’ve had stages where we’ve had naproxen 250, we’ve had naproxen 500 – which they’re different strengths – but then we’ve had slow release versions – GR versions as they’re called – and depending on what’s available at a particular time we’ll have one out of four or maybe two out of four and actually what we need to be able to do is say – well, this is what I can get today, this, under this protocol mean I can give this instead.  And for that to happen automatically without me having to defer back to you as a doctor.

 

Porter

And when’s this going to happen?

 

Soni

So, we’re expecting this protocol to be in place in the next couple of weeks, it’s part of the Brexit plan, as part of the strategy for the regulations to be laid.

 

Ash Soni, suggesting there is some light at the end of the tunnel.  And there is more information on the rule changes he mentioned on the Inside Health page of the Radio 4 website.

 

Short-sightedness or myopia is a growing problem.  The number of children with myopia in UK has doubled in the last 50 years, with one in seven teenagers now affected.  And it’s even more common elsewhere.

 

Actuality

 

Tan

My name is Donald Tan, I’m the Arthur Lim Professor at the Singapore National Eye Centre.  Today, globally, one in four people in the world are myopic and that means you can’t see without glasses, right?  There are studies to show that by 2050 half the world, one in two individuals globally, will be myopic.  It’s astonishing.  The reason why there is a current global epidemic of myopic in which the myopic rates around the world are gradually but surely increasing is not the genes, genes don’t change, it is the environment.  One of the strongest evidence we have is that outdoor activities are protective, so if you do more sports, you’re outdoors more, maybe lighting, maybe relaxing your eyes into the distance when you’re playing games, that helps to reduce myopia.

 

Porter

And this is why children in Singapore are being encouraged to keep myopia at bay by going outdoors to play.

 

Actuality – children playing

Keep myopia at bay, go outdoors and play.

 

Porter

But there’s another approach to tackling myopia that is popular in that part of world that’s almost unheard of here – atropine eye drops.  And Donald Tan is one of the researchers investigating the preventive powers of a drug better known in the UK for treating worrying slow heart rates, or as an ancient beauty product that dilates the pupils to make the user look more alluring.

 

Tan

Atropine is an old drug, we’ve been using it for years, it’s used in cardiology.  It’s based on a plant, belladonna, but it is actually a neurotransmitter.  So, we can use this in the form of eye drops to change or alter eye growth and it reduces myopia because myopia is basically a condition where the length of the eyeball is too long, it just grows too much in childhood.  And when people started using atropine, we quickly realised that it seems to reduce this abnormal eye growth.  And so, it reduced myopia.

 

Porter

Atropine may be a popular remedy in Asia, but it’s hardly used at all in Europe.  However, that could soon change thanks to a new study.  Called CHAMP-UK it is being led by Professor Augusto Azuara-Blanco from Queen’s University, Belfast, who has more than a professional interest in myopia.

 

Azuara-Blanco

Actually, for me it’s a bit of a personal story because my daughter she’s short-sighted and she started wearing glasses when she was about seven and I wanted to get hold of atropine and I couldn’t.  And then, of course, my academic background thought perhaps we should do a trial and that’s how I started performing.

 

Porter

Why is it used in other parts of the world but not here?

 

Azuara-Blanco

Well I think it’s mainly in Europe mainly because the regulatory agencies haven’t approved and mainly because we don’t have perhaps very strong evidence that it works in our populations.

 

Porter

You say we haven’t got strong evidence that it works but does it work?

 

Azuara-Blanco

So, some years ago there was a trial in Singapore, they were trying to have lower doses and lower doses of this atropine to see whether it could still work but without all the side effects of blurring the vision and dilating the pupils.  And they found – it was a surprising finding – because the lowest concentration in this trial, which are very low, like a hundredth of the concentration that we use in the clinic, appeared to be the most effective.  And we couldn’t understand why.

 

Porter

And this would be using the drug daily, regularly, all the time to prevent the natural progression of short-sightedness…

 

Azuara-Blanco

Well again that’s a very good question.  The trials from Singapore treated kids for two years and then they stopped and looked what happened after stopping the drops.  And again, most interestingly, the group that had the lowest concentration appeared to remain stable and in some children with higher concentration, although it was effective, there appeared to be a rebound effect, so the myopia progressed after stopping the treatment.

 

Porter

So, it sort of caught up basically, yeah…

 

Azuara- Blanco

Yes.

 

Porter

…they came off the treatment and it bounced back.  But for the group given the lowest concentration there seemed to be some sustainable benefit?

 

Azuara-Blanco

Yeah.

 

Porter

So, the situation was that you wanted to use atropine drops in your own child?

 

Azuara-Blanco

Yeah.

 

Porter

You weren’t convinced by the evidence out there, so what are you doing about it?

 

Azuara-Blanco

The way of trying to do that is to do a trial to ask whether this low dose atropine works well and is safe and well tolerated in children with myopia in the UK.

 

Porter

So, you’re looking for efficacy, number one, to see whether it actually works…

 

Azuara-Blanco

Works.

 

Porter

…and the implications of this research are quite profound, this is a very cheap medication, potentially, it’s very easy to administer, hopefully at low doses have very few side effects.  And we’re talking about it being able to halt the progression, that’s what you would aim for, that’s what you would regard as a good result?

 

Azuara-Blanco

I think yes, I think that will be a very good result because again those – we know that there are substantial problems with progression of myopia to very high levels, we know that some of these people will have a substantial and significant risk of visual loss later on in life.  So, stopping myopia, that will be very good news for everybody.

 

Porter

How does it feel to be running a trial that could have such huge ramifications?

 

Azuara-Blanco

This is what I like to do, I mean I’m a clinician and I enjoy very much trying to improve patients’ vision and outcomes but the possibility of having a more widespread contribution I think that’s what excites me.

 

Porter

When do you think you might get an answer, if all goes well?

 

Azuara-Blanco

Okay, so within three years, four at the most, I think we’re going to have a definite answer.

 

Porter

So, your daughter might not benefit but maybe her daughter might one day?

 

Azuara-Blanco

Absolutely, hopefully.

 

Porter

Augusto Azuara-Blanco talking to me in Belfast.  More information, as ever, on our website, where you can also find out how to get in touch.

 

Tracey emailed Inside Health to ask about weight loss, or, in her case, weight gain.

 

Tracey (email)

I am a life-long member of Weight Watchers and recently, ahead of a mountain climb, I have been in training to get fitter.  According to my gym’s computer I had ‘trained like a sportsperson’ and I had also been very careful with what I ate.  So, I was surprised to find, at my weekly weigh-in, that I had put on 2.5lbs.  Still, I took comfort in believing that muscle in my body weighs more than fat.

 

However, that evening I received an e-mail from Weight Watchers stating that even though I’d had a small weight gain, I wasn’t to worry and they would help me find my way back to healthy eating.  All very dispiriting.

 

Is my “muscle weighs more than fat” justification wrong?

 

Porter

Well I know just the person to ask – Jason Gill, Professor of Cardiometabolic Health at the University of Glasgow.

 

Gill

So, technically, a lot of people say muscle is heavier than fat, so muscle is more dense than fat, muscle is about 15% more dense than fat.  So, if you take a unit volume of muscle and a unit volume of fat the muscle will be heavier by about 15%.

 

Porter

So, what’s happening in Tracey’s body?  Presumably, she has burnt some fat but she’s put on some muscle and that’s why her weight’s crept up.

 

Gill

Yes, so we often see this scenario, people start to exercise and don’t lose weight.  And what’s happening is you are losing fat and you tend to be putting on a bit of lean mass or muscle mass.  And we know, for example, that if you do some exercise and don’t lose weight you can actually lose about 25% of the dangerous visceral fats, this is the fat which surrounds your internal organs.  So, you’re clearly improving your health but it might not be indicated when you step on the scales.

 

Porter

And that fat is important because this is the metabolically bad fat, this is the unhealthy fat?

 

Gill

This is the unhealthy fat which increases risk of diseases like Type 2 diabetes, yes.

 

Porter

But you stand on the scales and you could be a bit disillusioned because we’ve been – it’s been drilled into us hasn’t it that it’s the weight that matters.

 

Gill

Yeah, weight does matter but it’s not the only thing that matters.  So, one of the things you can think about is if you’re not losing weight you might find your waist circumference is getting smaller, so sometimes you find that your trousers fit a little bit more loosely, your clothes fit a little bit better but the scales are not telling you the story that you want them to.  And I think you should look at these indicators as well.  So, if your trousers are fitting a bit more loosely, you’re going to be doing yourself some good.

 

Porter

Paradoxically is there not a danger if we concentrate purely on the weight side of things that we look at what the scales are telling us and if we just, for instance, lost weight through calorie restriction of some sort, that actually that might not be as healthy as doing some weight loss calorie restriction and some exercise?

 

Gill

So, weight loss is generally beneficial if you are too heavy.  And even if you don’t do any exercise and lose weight just through eating less, the evidence suggests that you are getting a clear benefit from that.  When you lose weight through just restricting the amount of food you eat, about a quarter to a third of the weight that you lose is actually muscle, it’s lean tissue, so for every 10 pounds of weight that you lose you’re probably losing maybe seven pounds of fat and three pounds of muscle or lean tissue.  And what happens when you do some exercise is you can actually preserve the lean tissue when you lose weight, so more of the weight that you lose is fat.

 

Porter

So, a combination regime would be a good idea.  What happens if you just go for exercise alone, so you don’t change what you’re eating but you decide that you try and get in shape and lose some weight purely by doing exercise – does that work?

 

Gill

So, if you do enough exercise yes it does work.  The thing is you have to do a lot of exercise to see a benefit there.  The average person who, says, does a half hour brisk walk or a half hour jog might burn two to four hundred calories and if you sort of calculate how many calories you need to lose a kilogram of fat it’s about 7,700 calories you need to lose a kilogram of fat.  So, you have to do a lot of walking or running.  So, if you’re just trying to lose weight by exercise, it’s unlikely to be very successful and you probably need to restrict the amount of food you eat and do a bit more physical activity to maximise the benefit there.

 

Porter

Does exercise have a significant impact on the rate at which we might burn fat?  I mean if you do exercise do you burn more fat than somebody who doesn’t – calorie for calorie – or is it just about the calorie balance?

 

Gill

You do burn more fat.  So, what we’ve shown and others have shown as well is that if you do an exercise session and you measure the type of calories you are burning over the next day or so, what you find is you’re not necessarily burning very many more total calories but you’re burning a bigger proportion of calories from fat.  And if we think about it, to lose fat what we need to do is burn more fat calories than we are consuming, if we want to reduce the amount of fat in our body.  So, by increasing the number of fat calories that we are burning, that’s one of the reasons why exercise could help reduce fat mass and to cause fat loss without necessarily causing weight loss, which is one of the reasons why we see when people exercise and don’t lose weight, they can actually lose substantial amounts of fat.

 

Porter

And is there evidence that the sort of fat that they’re burning and losing, hopefully, is likely to be this more dangerous visceral fat or does it come from all over the body including the visceral fat?

 

Gill

So, the evidence is that however you lose weight it seems to be the more dangerous visceral fat and ectopic fat, so ectopic fat is fat in places where it shouldn’t be, so we’ve got ectopic fat in the liver, for example and the evidence is that when you lose fat, by whatever means, we tend to lose the more dangerous visceral and ectopic fat first.  So, when you exercise and you’re not really losing a lot of overall body fat, necessarily, you are disproportionately losing fat from the dangerous places.  So, the first bit of fat that you lose, however you lose the fat, is giving you the most benefit.

 

Porter

Jason Gill.

 

Well, Tracey may be fitter and stronger following her training, but the same can’t be said for most of us, particularly as our muscles start to shrink and weaken with age, a process known as sarcopenia, and something that happens to us all to some degree.  Never heard of it?  Well, you are not alone.

 

Rheumatologist Elaine Dennison is Professor of Musculoskeletal Epidemiology at the University of Southampton.

 

Dennison

Our knowledge about muscle and really our appreciation of how important it is, I think has been quite sort of late, quite slow, relative to a lot of other conditions.

 

Porter

Well, let’s unpick the muscle story.  What happens to muscles as we age?

 

Dennison

What normally happens is that we get loss of the amount of muscle we have, weakening, so loss of strength of the muscle that we have and that impacts what we can do, so our physical performance.  So, normally what we see is that actually people have smaller muscles that aren’t as strong and if we test their muscle strength and what they’re able to do, that tends to be less strong in later life compared to, say, mid-life or earlier on.

 

Porter

And when does that process start in most people?

 

Dennison

Depressingly early actually, I think probably the sort of peak muscle mass is probably sort of 30-40, I mean certainly you can chart changes from 50, but 30-40 is quite a key time actually.

 

Porter

Can you give us an idea of the rate of loss?  I mean assuming somebody reaches peak muscle mass by the end of their 30s, how quickly are they likely – I know it depends on their lifestyle – but typically, for the average person, how quickly are they likely to lose bulk?

 

Dennison

Yeah, so the figure that’s normally quoted, certainly past the age of about 50, is about 1% a year, so that gives you a sense of the loss of muscle mass.

 

Porter

What are the implications of losing muscle bulk and strength?  I mean obviously, you become weaker, I think all of our listeners would expect not to be able to run as fast or to lift as heavy weights as they get older, but what are the implications that you see as a clinician?

 

Dennison

Yeah, so, I mean the implications can be huge.  So, as a clinician obviously one thing we tend to see are more falls but also it translates into difficulty – actually with managing day-to-day activities.  And you see interrelationships, so for example, if someone has osteoarthritis – wear and tear arthritis – of the knee, one of the things that, as a rheumatologist, we’ll often say to people is that it’s really important that actually they maintain their muscle strength around that joint because actually that seems to help with levels of pain and ability to cope with that arthritis.  So, often the muscle is protective for the joints.

 

Porter

But this is often a vicious downward spiral for many people, isn’t it, I mean they have problems with their knees so they avoid exercise because they feel they’re going to wear the joint out and it hurts.  They might move from a house to a bungalow, so they don’t have to manage stairs, they might have a chair that propels them out of their seat, so that they find it easier to stand up – all of which, of course, is making them weaker.

 

Dennison

Absolutely, absolutely and that – it is very much a vicious cycle, which is why prevention is really important and obviously we have to do everything we possibly can to try and stop development of sarcopenia.  But actually, for people who are thinking well actually perhaps I’m already weaker than I would like to be, there are studies that show that these things can be reversable and actually with the right exercise programmes and things you can really improve your muscle mass and strength and function.  So, the situation’s never hopeless, there are always things that we can do.

 

Porter

Well, let’s look at prevention first of all, Elaine, what piece of single advice do you think is most important for people listening who are concerned that they may be getting weaker?

 

Dennison

Resistance exercise seems to be key.  So, incorporating some kind of exercise into your daily routine, three times a week, that has got a significant resistance component to it.  And obviously, that can be in a gym setting but it doesn’t have to be.  But that kind of regular commitment is what you need.

 

Porter

Of course, another problem is that a lot of middle-aged, certainly, people concentrate mostly on cardiovascular fitness, you know we’ve been taught for decades that it’s good to run, to cycle, to swim, to use stepper machines and while they must – they might all help your muscles they’re not building strength across the whole system, are they?

 

Dennison

No, and that’s the thing, it’s always difficult isn’t it, when people get conflicting advice about what they should do to try and promote their health.

 

Porter

The heart’s an important muscle but it’s not the only one.

 

Dennison

Yeah, there are others.

 

Porter

Elaine Dennison.

 

And the latest guidelines on exercise, including resistance and weights, are on our website.

 

Just time to tell about next week’s programme, when we return to one of our favourite themes – conflict of interest.  Is it right for charities and public health bodies to work closely with drinks manufacturers – alcoholic or sugary?

 

ENDS

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