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2024年08月03日
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孫勝副主任醫(yī)師 北京朝陽醫(yī)院石景山院區(qū) 骨科 1.常有關(guān)節(jié)損傷史，多見于青少年。2.早期以關(guān)節(jié)活動(dòng)時(shí)疼痛，局部溫度升高，腫脹，關(guān)節(jié)活動(dòng)逐漸受限。?????3.在關(guān)節(jié)周圍可以摸到異常骨塊，該骨塊可逐漸增大，以后又可緩慢回縮至骨塊成熟?！痉派鋵W(xué)表現(xiàn)】軟組織的放射線檢查在發(fā)病最初的2周后并無異常表現(xiàn)。在2～4周的時(shí)間內(nèi)鈣化逐漸變得明顯，完全成熟的病變可以在大約14周后看到，在創(chuàng)傷后大約5個(gè)月，骨化的過程完全停止。2023年05月19日265
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2023年04月21日37
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王夢(mèng)陽主任醫(yī)師 醫(yī)生集團(tuán)-北京 神經(jīng)內(nèi)科 啊，下面這個(gè)問題呢，是關(guān)于肌肉萎縮的問題，全身游走性跳動(dòng)，一年半病情了，做了六次肌電圖沒查出來。 該怎么辦??？我看你這個(gè)應(yīng)該是焦慮癥啊。 你老懷疑自己是漸凍癥啊，現(xiàn)在恐漸凍癥的人很多啊，當(dāng)然還有恐別的，我見過很多不同的恐各種病的，有恐得了癌癥的啊，有恐得了艾滋病的。 有恐得了漸凍癥的啊。 嗯，有恐自己腦萎縮的啊，反正是這些人的共同特點(diǎn)，都是焦慮癥啊。 就是強(qiáng)迫思考一個(gè)問題。 已經(jīng)做了六次機(jī)電圖，都一年半了，都沒有查出來。 你要漸凍癥的話，一年半人都已經(jīng)上呼吸機(jī)了，快是吧？ 都不行了，你這個(gè)別說機(jī)電圖了。 那什么圖都不正常啊，那六次機(jī)電圖都是正常的。 你該怎么辦？去看心理醫(yī)生啊，吃抗焦慮的藥物。 做心理治療。2023年03月18日215
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2022年12月25日64
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2022年12月09日183
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陶可主治醫(yī)師 北京大學(xué)人民醫(yī)院 骨關(guān)節(jié)科 肌肉減少癥的病因、治療及康復(fù)鍛煉：最新研究進(jìn)展陶可（北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科）什么是肌肉減少癥？肌肉減少癥這個(gè)詞的意思是“缺乏肌肉”，一旦你了解了這種情況，它就明白了。肌肉減少癥是一種與年齡相關(guān)的肌肉退化有關(guān)的疾病。它在50歲以上的人群中更相關(guān)也更常見。30歲以后，人開始失去肌肉力量。根據(jù)2004年發(fā)表在CurrentOpinioninClinicalNutritionandMetabolicCare上的一篇評(píng)論，人們往往每十年失去3%到8%的肌肉力量(1)。失去肌肉力量會(huì)降低您進(jìn)行日?；顒?dòng)和日常任務(wù)的能力。它可能會(huì)增加患?xì)埣?、失去?dú)立性和需要護(hù)理的風(fēng)險(xiǎn)。它可能會(huì)增加跌倒、事故、受傷、骨折、住院、手術(shù)和術(shù)后并發(fā)癥的風(fēng)險(xiǎn)?？紤]到住院和家庭護(hù)理的費(fèi)用，肌肉減少癥也會(huì)變得非常昂貴。根據(jù)WorldviewsonEvidence-BasedNursing發(fā)表的2016年評(píng)論，肌肉減少癥還可能縮短您的壽命(2)。根據(jù)2015年發(fā)表在《營(yíng)養(yǎng)學(xué)會(huì)會(huì)刊》上的一篇評(píng)論，肌肉減少癥的發(fā)生可能是由于肌肉細(xì)胞生長(zhǎng)（合成代謝）信號(hào)和分解信號(hào)（分解代謝）信號(hào)之間的不平衡(3)。在一個(gè)健康的身體里，你的生長(zhǎng)激素與蛋白質(zhì)破壞酶一起工作，在肌肉生長(zhǎng)、壓力、損傷、分解、破壞、修復(fù)和恢復(fù)的持續(xù)循環(huán)中保持你的肌肉健康和肌肉質(zhì)量穩(wěn)定。在衰老的身體中，信號(hào)之間的不平衡和對(duì)生長(zhǎng)信號(hào)的抵抗可能會(huì)發(fā)展，這會(huì)導(dǎo)致比合成代謝和肌肉生長(zhǎng)更多的分解代謝和肌肉損失。圖1?agingmuscle:衰老的肌肉肌肉減少癥的癥狀肌肉減少癥的癥狀可能包括：?肌肉無力，?（容易）摔倒，?步行速度減緩慢?自我報(bào)告的肌肉萎縮?難以執(zhí)行或參與正常的日常任務(wù)和活動(dòng)?運(yùn)動(dòng)時(shí)容易感到疲勞肌肉減少癥的根本原因如果您有任何健康問題，請(qǐng)務(wù)必查看問題的根本原因。如果我們著眼于問題的根本原因，我們就可以制定治療策略來解決這些問題，而不是僅僅在癥狀上貼上創(chuàng)可貼（即大家經(jīng)常說的：治標(biāo)不治本）。肌肉減少癥的根本原因可能包括：圖2?肌肉減少癥的影響與危害：25%的65歲及以上人群受到影響，60%的80歲以上人群受到影響，以肌肉萎縮和活動(dòng)減少為主要特征。（1）炎癥反應(yīng)：可導(dǎo)致的肌肉減少癥術(shù)語炎癥，也稱為炎癥老化，是指隨著年齡的增長(zhǎng)而出現(xiàn)的炎癥反應(yīng)上調(diào)和全身低度炎癥。炎癥會(huì)加速衰老過程，并可能使一些與年齡相關(guān)的癥狀和疾病惡化。根據(jù)2013年發(fā)表在Longevity&Healthspan上的一項(xiàng)研究，炎癥可能是先天和后天免疫系統(tǒng)的結(jié)果，它可以增加體內(nèi)炎性細(xì)胞因子的產(chǎn)生(4)。這會(huì)促進(jìn)炎癥并導(dǎo)致與年齡相關(guān)的健康問題，包括肌肉衰退。2013年發(fā)表在Thorax上的一項(xiàng)研究發(fā)現(xiàn)，患有慢性阻塞性肺病(COPD)和相關(guān)慢性炎癥的患者的肌肉質(zhì)量也有所下降(5)。還有許多其他以長(zhǎng)期慢性炎癥為特征的疾病，包括慢性感染、炎癥性腸病和自身免疫性疾病，可能會(huì)增加肌肉減少和肌肉減少癥的風(fēng)險(xiǎn)。根據(jù)2016年發(fā)表在Maturitas上的系統(tǒng)回顧和薈萃分析，較高水平的C反應(yīng)蛋白可能與慢性炎癥和肌肉減少癥有關(guān)(6)。圖3?炎癥可通過一系列復(fù)雜的機(jī)制和病理過程，影響我們身體的各個(gè)重要器官：腦心肝腎肺、肌骨皮膚、腸道和甲狀腺等。（2）蛋白質(zhì)攝入不足：可導(dǎo)致的肌肉減少癥遵循低營(yíng)養(yǎng)素和高精制糖、精制油、人工成分和過度加工食品的不健康飲食會(huì)增加慢性炎癥。注意您的常量營(yíng)養(yǎng)素也很重要。熱量和蛋白質(zhì)含量過低的飲食不僅會(huì)導(dǎo)致體重減輕，還會(huì)導(dǎo)致肌肉質(zhì)量下降。蛋白質(zhì)對(duì)肌肉健康、肌肉質(zhì)量和肌肉力量至關(guān)重要。蛋白質(zhì)攝入不足可能導(dǎo)致肌肉減少癥。隨著年齡的增長(zhǎng)，許多人的牙齒和牙齦出現(xiàn)問題，吞咽困難，口味和食欲發(fā)生變化，購(gòu)物和烹飪的挑戰(zhàn)也越來越大。這會(huì)增加他們無法滿足蛋白質(zhì)和熱量需求的風(fēng)險(xiǎn)。根據(jù)2015年發(fā)表在《臨床醫(yī)學(xué)研究雜志》上的一篇評(píng)論，每餐攝入25至30克蛋白質(zhì)可能有助于降低肌肉減少癥的風(fēng)險(xiǎn)(7)。圖4?蛋白質(zhì)攝入對(duì)人體的8點(diǎn)益處：①維持穩(wěn)定的血糖；②改善脂肪利用效率；③促進(jìn)肌肉重建；④提高記憶與學(xué)習(xí)能力；⑤保持積極的心態(tài)；⑥心臟正常的功能所必須；⑦減緩衰老進(jìn)程并有可能長(zhǎng)壽；⑧改善骨密度（3）胃酸水平低：所致的肌肉減少癥胃酸是一種水狀無色液體，由胃壁形成，可促進(jìn)消化。顧名思義，胃酸是非常酸性的，它支持食物的分解以進(jìn)行適當(dāng)?shù)南Ｎ杆徇€有助于營(yíng)養(yǎng)物質(zhì)的適當(dāng)吸收。胃酸水平低下顯然會(huì)導(dǎo)致消化問題。如果您的胃酸水平較低，您的身體可能無法分解和吸收食物中的蛋白質(zhì)和其他營(yíng)養(yǎng)物質(zhì)。這不僅會(huì)導(dǎo)致消化問題，還會(huì)導(dǎo)致慢性炎癥和健康并發(fā)癥。根據(jù)2022年發(fā)表在《營(yíng)養(yǎng)學(xué)》雜志上的一項(xiàng)研究，胃動(dòng)力差可能與老年人的肌肉減少癥有關(guān)(8)。2019年發(fā)表在《科學(xué)報(bào)告》(ScienceReports)上的一項(xiàng)研究將與低胃酸水平相關(guān)的胃食管反流病與骨骼肌衰減不良和肌肉減少癥聯(lián)系起來(9)。圖5?胃酸的7大主要功能：①殺滅食物中的病菌，達(dá)到無菌化處理；②蛋白質(zhì)分解；③激活胃蛋白酶（胃內(nèi)最重要的消化酶）；④活化內(nèi)源性因子；⑤促進(jìn)膽汁和膽酶轉(zhuǎn)運(yùn)（至十二指腸）；⑥關(guān)閉食管括約?。ㄎ傅娜肟?，以便胃酸不易反流至食管，造成胃食管反流病，避免食管胃酸液的化學(xué)性腐蝕、損傷）；⑦打開幽門括約?。ㄎ傅呐懦隹冢员憬?jīng)胃酸消化的食物，進(jìn)入小腸內(nèi)，便于吸收）（4）腸道菌群失調(diào)：可致肌肉減少癥您的腸道是數(shù)萬億細(xì)菌和微生物的家園。其中一些微生物對(duì)您的健康有益，而另一些則對(duì)您的健康有害。關(guān)鍵是腸道微生物失衡，有益細(xì)菌多于有害細(xì)菌。不幸的是，炎癥性飲食、不良的生活方式選擇、營(yíng)養(yǎng)失衡、壓力、環(huán)境毒素和其他因素都會(huì)破壞平衡。腸道菌群失調(diào)意味著腸道微生物群失衡，有害細(xì)菌過多而有益細(xì)菌過少。腸道菌群失調(diào)會(huì)導(dǎo)致慢性炎癥和慢性嚴(yán)重健康問題的風(fēng)險(xiǎn)。它還可能增加患肌肉減少癥的風(fēng)險(xiǎn)。2018年發(fā)表在MediatorsofInflammation上的一項(xiàng)研究發(fā)現(xiàn)，腸道菌群失調(diào)可能在與年齡相關(guān)的炎癥、炎癥、肌肉老化和肌肉減少癥中發(fā)揮作用(10)。研究人員發(fā)現(xiàn)，在解決肌肉減少癥時(shí)，針對(duì)腸道菌群失調(diào)可能很重要。發(fā)表在惡病質(zhì)、肌肉減少癥和肌肉雜志（Cachexia,Sarcopenia,andMuscle）上的2021年系統(tǒng)綜述支持了這些發(fā)現(xiàn)，并發(fā)現(xiàn)腸道生態(tài)失調(diào)可能在肌肉減少癥的發(fā)展中發(fā)揮關(guān)鍵作用(11)。圖6?腸道菌群失調(diào)是腸道內(nèi)菌群的失平衡，即有益菌（益生菌，goodbacteria）減少的同時(shí)，機(jī)會(huì)致病菌（有害菌，opportunisticbacteria）大量繁殖（5）慢性壓力和睡眠質(zhì)量差：可致肌肉減少癥慢性壓力和睡眠不佳是慢性炎癥、炎癥和與年齡相關(guān)的健康問題（包括肌肉減少癥）背后的主要潛在因素。根據(jù)2018年發(fā)表在激素雜志上的一項(xiàng)研究，慢性壓力可能在身體成分失調(diào)中發(fā)揮作用，包括肌肉減少癥(12)。與健康問題相關(guān)的慢性和嚴(yán)重壓力也可能導(dǎo)致肌肉減少癥。根據(jù)2015年發(fā)表在《營(yíng)養(yǎng)學(xué)會(huì)會(huì)刊》上的評(píng)論、2016年發(fā)表在《當(dāng)前胃腸病學(xué)報(bào)告》上的評(píng)論、2016年發(fā)表在《腎泌尿?qū)W月刊》上的評(píng)論和2016年發(fā)表在《營(yíng)養(yǎng)學(xué)會(huì)會(huì)刊》上的評(píng)論，與慢性壓力相關(guān)的壓力肝病、慢性心力衰竭、慢性腎病和癌癥治療可能會(huì)導(dǎo)致肌肉減少和肌肉減少癥(13,14,15,16)。慢性壓力會(huì)導(dǎo)致睡眠不佳。然而，睡眠不足也會(huì)導(dǎo)致慢性壓力。睡眠不佳和慢性壓力都會(huì)增加慢性炎癥。而慢性炎癥會(huì)導(dǎo)致睡眠不佳和慢性壓力。慢性壓力、睡眠不佳和慢性壓力的循環(huán)會(huì)增加肌肉流失的風(fēng)險(xiǎn)。2017年發(fā)表在《醫(yī)學(xué)》（巴爾的摩）雜志上的一項(xiàng)橫斷面研究發(fā)現(xiàn)睡眠持續(xù)時(shí)間與肌肉減少癥之間存在聯(lián)系(17)。根據(jù)發(fā)表在《臨床醫(yī)學(xué)雜志》上的2019年系統(tǒng)評(píng)價(jià)和薈萃分析，睡眠質(zhì)量差會(huì)對(duì)肌肉減少癥產(chǎn)生負(fù)面影響(18)。圖7?慢性壓力的主要癥狀（磨牙、冷漠、注意力不能集中、易憤怒、焦慮、頭痛、肌肉緊張、胃腸道病、皮膚刺激、性欲下降、易疲勞）及其對(duì)身體的影響巨大teethgrinding,apathy,troubleconcentrating,anger,anxiety,headaches,muscletension,stomachproblems,skinirritations,decreasedsexdrive,fatigue肌肉減少癥的自然支持防治策略幸運(yùn)的是，在一些簡(jiǎn)單的飲食、生活方式和營(yíng)養(yǎng)補(bǔ)充策略的幫助下，您可以自然地改善健康。我推薦以下針對(duì)肌肉減少癥的自然支持策略：（1）抗炎營(yíng)養(yǎng)計(jì)劃慢性炎癥反應(yīng)是肌肉減少癥的一些主要原因(4,5,6)。炎癥性飲食是慢性炎癥和炎癥的主要驅(qū)動(dòng)因素之一。食用精制糖和精制油會(huì)加劇炎癥并加速炎癥，這可能會(huì)導(dǎo)致肌肉減少癥。根據(jù)2020年發(fā)表在《營(yíng)養(yǎng)雜志》上的一項(xiàng)研究，飲食的炎癥潛力與患肌肉減少癥的風(fēng)險(xiǎn)之間存在聯(lián)系(19)。我建議去除所有精制糖和碳水化合物、精制油、人造成分、油炸食品、垃圾食品和過度加工食品。食用富含營(yíng)養(yǎng)和抗炎天然食物的飲食。多吃綠色蔬菜、香草、香料、豆芽、發(fā)酵食品、低升糖指數(shù)水果（如蘋果、香蕉、番茄、橙子等）、草飼牛肉、內(nèi)臟肉、牧場(chǎng)飼養(yǎng)的家禽和雞蛋、草飼動(dòng)物的黃油和酥油、野生魚和野生動(dòng)物（禁止吃國(guó)家野生動(dòng)物保護(hù)法明文保護(hù)的動(dòng)物）。盡可能吃有機(jī)食品。圖8?抑制炎癥反應(yīng)的食物（anti-inflammatoryfoods）與促進(jìn)炎癥反應(yīng)的食物（pro-inflammatoryfoods）圖8-1?精煉油Refinedoil只不過是普通油的“精煉”版本。精煉過程涉及化學(xué)物質(zhì)，這些化學(xué)物質(zhì)在一定數(shù)量上對(duì)我們的健康有害。油的“凈化”是通過用酸、堿或漂白處理來完成的。精制油也經(jīng)過中和、過濾或除臭。所有這些過程都涉及己烷等化學(xué)品Refinedoilisnothingbutthe'refined'versionofthenormaloil.Theprocessofrefininginvolveschemicals,whichincertainquantities,areharmfultoourhealth.The'purification'oftheoilisdonebytreatingitwithacid,alkaliorbybleaching.Refinedoilisalsoneutralized,filteredordeodorized.Alloftheseprocessesinvolvechemicalssuchashexane（2）優(yōu)質(zhì)蛋白質(zhì)的攝入蛋白質(zhì)攝入不足會(huì)導(dǎo)致肌肉流失并增加患肌肉減少癥的風(fēng)險(xiǎn)(7)。確保在營(yíng)養(yǎng)豐富、抗炎的飲食中攝入足夠的蛋白質(zhì)。目標(biāo)是每磅體重?cái)z入0.5至1克蛋白質(zhì)。我建議您主要關(guān)注健康的動(dòng)物性蛋白質(zhì)，包括草飼牛肉、內(nèi)臟肉、牧場(chǎng)飼養(yǎng)的家禽和雞蛋、野生魚類和海鮮（痛風(fēng)患者需注意選擇不易影響血尿酸的食物）。如果您難以通過食物滿足蛋白質(zhì)需求，可以使用蛋白粉來幫助獲取足夠的蛋白質(zhì)。堅(jiān)果和種子可以添加額外的植物性蛋白質(zhì)。我不推薦豆類和小扁豆，尤其是不要大量食用，因?yàn)樗鼈兊奶妓衔锖亢芨撸赡軙?huì)導(dǎo)致消化不適。我建議避免食用谷物，因?yàn)樗鼈兒宣熧|(zhì)和碳水化合物。圖9?決定蛋白質(zhì)攝入的目標(biāo)：①體重控制減少，每日攝入蛋白量1-1.5g/kg體重，如果您的體重是70kg，那么每天蛋白質(zhì)需要70-105g即可；②重塑肌肉，每日攝入蛋白量1.5-2.0g/kg體重，如果您的體重是70kg，那么每天蛋白質(zhì)需要105-140g即可；③運(yùn)動(dòng)員，每日攝入蛋白量1.8-2.5g/kg體重，如果您的體重是70kg，那么每天蛋白質(zhì)需要126-175g即可；④久坐不動(dòng)的朋友，每日攝入蛋白量1.0-1.2g/kg體重，如果您的體重是70kg，那么每天蛋白質(zhì)需要70-84g即可sedentaryindividuals（3）抗阻力訓(xùn)練缺乏運(yùn)動(dòng)和久坐不動(dòng)的生活方式會(huì)增加肌肉無力、肌肉流失和肌肉減少癥的風(fēng)險(xiǎn)。根據(jù)2015年發(fā)表在《臨床密度測(cè)定雜志》上的一篇評(píng)論，沒有充分使用肌肉是肌肉減少癥的主要驅(qū)動(dòng)因素之一(20)。根據(jù)2016年發(fā)表在《脆弱與衰老雜志》上的一篇評(píng)論，生病或受傷后臥床休息和不活動(dòng)會(huì)導(dǎo)致老年人肌肉快速流失(21)。由于不活動(dòng)和久坐不動(dòng)的生活方式導(dǎo)致的肌肉力量下降會(huì)導(dǎo)致疲勞、虛弱和力量不佳，這可能會(huì)使鍛煉變得更加困難，運(yùn)動(dòng)的動(dòng)力也會(huì)降低。這會(huì)導(dǎo)致不活動(dòng)、肌肉損失和疲勞的惡性循環(huán)。定期移動(dòng)身體，更重要的是，進(jìn)行阻力和力量訓(xùn)練對(duì)于提高肌肉力量、質(zhì)量和健康以及降低肌肉減少癥的風(fēng)險(xiǎn)至關(guān)重要。我建議每周至少進(jìn)行3到4天的阻力訓(xùn)練。嘗試復(fù)合運(yùn)動(dòng)，例如深蹲、硬拉、推舉、劃船等。與物理治療師或教練一起工作可以幫助您學(xué)習(xí)正確的形式，安全地嘗試新的練習(xí)，并有效地提高您的力量。如果您正從一段時(shí)間的受傷、疾病或不活動(dòng)中恢復(fù)過來，這可能尤為重要。如果您對(duì)阻力訓(xùn)練和鍛煉完全陌生，這也是一個(gè)不錯(cuò)的選擇。圖10?高強(qiáng)度間歇和阻力訓(xùn)練的對(duì)于肌肉減少癥明顯有益（選擇適合自己的日常鍛煉方式，量力而行）highintensityintervalandresistancetrainingbenefits（4）限時(shí)飲食或間歇性禁食限時(shí)進(jìn)食或間歇性禁食也可能有助于降低肌肉減少癥的風(fēng)險(xiǎn)。根據(jù)2014年發(fā)表在《國(guó)際健康科學(xué)雜志》(Qassim)上的一項(xiàng)研究，間歇性禁食可以減少炎癥和相關(guān)疾病的風(fēng)險(xiǎn)(22)。1988年發(fā)表在《臨床研究雜志》上的一項(xiàng)研究發(fā)現(xiàn)，間歇性禁食還可以改善人類生長(zhǎng)激素(HGH)的分泌和水平，從而有助于改善肌肉質(zhì)量(23)。根據(jù)2019年發(fā)表在《營(yíng)養(yǎng)學(xué)》雜志上的一項(xiàng)研究，間歇性禁食還可以提高支持關(guān)節(jié)和皮膚健康的膠原蛋白水平24)。我建議實(shí)行限時(shí)進(jìn)食。理想情況下，我建議在6到10小時(shí)的進(jìn)食窗口和14-18小時(shí)的禁食窗口期間進(jìn)食。如果您不熟悉限時(shí)喂食，請(qǐng)從12小時(shí)的隔夜禁食開始。晚餐后停止進(jìn)食，直到12小時(shí)后的第二天早餐才進(jìn)食。逐漸延長(zhǎng)禁食時(shí)間，直到找到適合自己的方法。記住不要在進(jìn)食窗口期間限制自己。食用含有大量健康脂肪、足夠蛋白質(zhì)和大量微量營(yíng)養(yǎng)素的抗炎全食，以滿足您的熱量和營(yíng)養(yǎng)需求。圖11?7步法輕松搞定間歇性禁食（每位朋友，可以根據(jù)自己情況量力而行，而非推薦必須執(zhí)行上述禁食）：①simplefast:12hours，簡(jiǎn)單常規(guī)的禁食12小時(shí)；②brunchfast:14hours，早午餐一起吃，禁食14小時(shí)，③crescendofast:16hours，漸進(jìn)式禁食16小時(shí)，每周2天，④cyclefast:16hours，循環(huán)禁食16小時(shí)，每周3次，⑤strongfast:18hours，增強(qiáng)禁食18小時(shí)，每天一次，⑥warriorfast:19-21hours，激進(jìn)禁食19-21小時(shí)，每天一次，⑦1dayfast:18hoursfasteachweek，徹底禁食24小時(shí)，每周一天（5）減輕壓力和改善睡眠質(zhì)量慢性壓力和睡眠不足可能會(huì)增加肌肉減少癥的風(fēng)險(xiǎn)(12,13,14,15,16,17,18)。減輕壓力水平和改善睡眠質(zhì)量可能會(huì)有所幫助。我建議練習(xí)冥想、呼吸、引導(dǎo)式放松技巧、祈禱和感恩，以降低壓力水平并更好地應(yīng)對(duì)壓力。寫日記可能有助于釋放情緒壓力并發(fā)現(xiàn)消極的心理漏洞。練習(xí)心態(tài)轉(zhuǎn)變和積極肯定。花時(shí)間在大自然中。花時(shí)間與支持你的朋友、家人和社區(qū)成員在一起。目標(biāo)是每晚睡7到9個(gè)小時(shí)。大約在同一時(shí)間睡覺和起床，以支持您的晝夜節(jié)律。睡前至少兩小時(shí)避免：①糖、②咖啡因、③過量飲食（最好是所有食物）、④酒精、⑤電子產(chǎn)品和⑥壓力過大。參加放松的活動(dòng)，例如拼圖、寫日記、閱讀、冥想、治療浴、喝涼茶，以及在晚上平靜地交談。買一張有支撐力的床、有支撐力且舒適的床墊、枕頭和床上用品、遮光窗簾和眼罩，以獲得更好的睡眠。圖12?良好夜間睡眠的方法：①床要舒適、②臥室盡量黑、③可以戴眼罩、④睡前8小時(shí)避免咖啡、⑤3小時(shí)前避免吃東西、⑥白天多曬太陽、⑦規(guī)律鍛煉，而非睡前鍛煉、⑧夜晚避免強(qiáng)亮燈環(huán)境、⑨九點(diǎn)入睡（6）改善胃酸水平胃酸水平低下也會(huì)導(dǎo)致肌肉減少癥(8,9)。改善胃酸水平至關(guān)重要。?①全天使用液體營(yíng)養(yǎng)：盡量確保至少一半的膳食是液體形式，例如蛋白質(zhì)奶昔或綠色奶昔（廣東人講究的喝湯是很有道理的）。蛋白質(zhì)奶昔是預(yù)代謝的，非常容易消化，不依賴于胃酸HCL的產(chǎn)生。如果您的胃酸HCL含量較低，每天喝一到兩杯蛋白質(zhì)奶昔可能會(huì)有所幫助，以支持氨基酸的吸收，減少對(duì)消化的額外壓力，并支持健康的胃酸水平。?②使用生姜：生姜是改善消化液的最佳物質(zhì)之一。我建議每天喝2至3杯姜茶，您可以將姜精油放入水中（2至3滴放入8盎司水中）(1盎司=31g=31ml)，每天將1/2英寸的新鮮姜根放入綠汁中(1英寸=2.54厘米)，然后使用在你的食物上磨碎生姜。您還可以在飲食中加入發(fā)酵生姜，這在泡菜等亞洲菜肴中很常見。由于辛辣食物可能會(huì)引發(fā)反流問題，因此請(qǐng)確保它不會(huì)為您引發(fā)。如果是，請(qǐng)專注于其他步驟。?③進(jìn)餐時(shí)間以外的超級(jí)水合物：良好的水合作用可以幫助激活腸蠕動(dòng)并推動(dòng)內(nèi)容物通過消化系統(tǒng)，從而減少體內(nèi)的微生物發(fā)酵和毒性。這有助于維持胃酸水平。?④吃肉時(shí)少喝水：當(dāng)您吃肉或任何較重的食物時(shí)，您應(yīng)該至少在餐前30分鐘停止飲用水或其他液體，除非您需要補(bǔ)充2盎司的水，在這些進(jìn)餐期間不喝水將減少胃液的任何潛在稀釋并允許更好的消化（飯前不建議大量飲水、吃水果、冷飲或果汁等稀釋胃液的物品）。?⑤飯后不要喝水：為了實(shí)現(xiàn)最佳消化，我還建議至少在飯后30分鐘后再喝水或其他液體。這允許適當(dāng)?shù)奈杆峄顒?dòng)、殺菌和蛋白質(zhì)代謝。?⑥使用檸檬和蘋果醋：擠壓新鮮檸檬或在肉類和蔬菜上使用檸檬汁或蘋果醋有助于預(yù)先代謝食物并支持更好的消化和營(yíng)養(yǎng)吸收（這可能是為何西方餐食，開胃配水，都會(huì)加上檸檬的原因）。您可以用檸檬或蘋果醋腌制食物，也可以在食用前將它們作為調(diào)料添加。再次確保蘋果醋不會(huì)引發(fā)任何反流癥狀，關(guān)注我的其他建議。?⑦開餐時(shí)吃蛋白質(zhì)食物：當(dāng)您開始進(jìn)食時(shí)，特別是當(dāng)您攝入蛋白質(zhì)時(shí)，胃會(huì)開始攪動(dòng)胃酸。雖然在他們的蛋白質(zhì)菜肴之前吃沙拉在文化上很常見，但這對(duì)您的胃酸HCL生產(chǎn)來說并不好。將蛋白質(zhì)與沙拉或蔬菜一起吃而不是之后吃是一個(gè)更好的主意。?⑧使用發(fā)酵蔬菜：酸菜、泡菜、泡菜、腌姜和其他發(fā)酵蔬菜等發(fā)酵食品都含有有機(jī)酸、酶和益生菌，有助于改善消化液分泌（韓國(guó)泡菜？但腌制的蔬菜可能會(huì)含有較多的細(xì)菌，且煙硝酸鹽含量往往過高，不建議多吃或經(jīng)常吃）。我建議您在所有較重的膳食中使用其中一種尤其是任何含蛋白質(zhì)的食物。?⑨使用發(fā)酵飲料：發(fā)酵飲料，如蘋果醋、椰子開菲爾和康普茶，具有抗菌功效，有助于減少細(xì)菌負(fù)荷，尤其是胃中的細(xì)菌，如幽門螺桿菌。保持幽門螺桿菌水平下降對(duì)于身體能夠產(chǎn)生足夠的胃酸至關(guān)重要。?⑩在最放松的時(shí)候吃最大的一餐：您的身體需要激活副交感神經(jīng)系統(tǒng)以產(chǎn)生足夠的胃酸。如果您很忙并且在旅途中，您將處于戰(zhàn)斗或逃跑的同情模式。如果您與低胃酸作斗爭(zhēng)，這種戰(zhàn)斗或逃跑狀態(tài)不會(huì)讓您的身體產(chǎn)生足夠的能量。飯前放松對(duì)改善胃酸分泌很重要。（心情愉快、精神壓力小時(shí)，是享用美味的大餐絕佳時(shí)機(jī)）圖13?10種改善胃酸的好方法（如上面①-⑩所述）（7）支持整體腸道健康和消化腸道菌群失調(diào)和腸道健康狀況不佳也可能增加患肌肉減少癥的風(fēng)險(xiǎn)(10,11)。我建議支持您的整體腸道健康和消化。2021年發(fā)表在《營(yíng)養(yǎng)前沿》(FrontiersinNutrition)上的一項(xiàng)研究發(fā)現(xiàn)，用益生菌和消化酶靶向腸道微生物群可能有助于肌肉減少癥(25)。2022年發(fā)表在惡病質(zhì)、肌肉減少癥和肌肉雜志上的一項(xiàng)研究發(fā)現(xiàn)，補(bǔ)充益生菌可能支持腸道肌肉軸，并可能減少與年齡相關(guān)的肌肉減少癥(26)。根據(jù)2018年發(fā)表在《臨床營(yíng)養(yǎng)和代謝護(hù)理當(dāng)前觀點(diǎn)》上的一篇評(píng)論，支持蛋白質(zhì)消化可能有助于減少與年齡相關(guān)的肌肉減少癥(27)。多吃富含益生菌的食物富含益生菌的食物包括酸菜、發(fā)酵香草、泡菜、開菲爾、康普茶和酸奶。然而，吃富含益生菌的食物不足以支持您的腸道菌群，尤其是當(dāng)您正在應(yīng)對(duì)腸道微生物失衡和各種慢性腸道健康問題時(shí)。益生菌可能有助于改善腸道微生物失衡和消化。我推薦使用Probiocharge1000億（藥店有一點(diǎn)商品化的非處方益生菌可以選擇：雙歧桿菌，培菲康等。在使用前請(qǐng)咨詢你的藥師或醫(yī)生。溫馨提示：益生菌不可以與抗生素等藥物同時(shí)服用，且最好用溫水送服）。為了進(jìn)一步支持您的消化，我還建議使用消化酶（乳酶生片等）。消化酶可能有助于減輕腹瀉和腸易激綜合征IBS的癥狀，這些癥狀通常與膽汁酸吸收不良有關(guān)。我推薦ProteoEnzymes來支持蛋白質(zhì)和整體消化。ProteoEnzymes?影響細(xì)胞因子和類花生酸的平衡，促進(jìn)關(guān)節(jié)舒適度并支持身體維持組織完整性的能力。它還有助于平衡免疫系統(tǒng)，降低自身免疫活性并分解體內(nèi)的致病性生物膜。ProteoEnzymes中的蛋白水解酶可以分解因受傷和組織損傷而產(chǎn)生的蛋白質(zhì)和復(fù)合物。據(jù)信，這項(xiàng)活動(dòng)有助于營(yíng)養(yǎng)和氧氣的輸送，并可能有助于加快身體恢復(fù)和愈合的能力。耐酸膠囊促進(jìn)酶的全身遞送。每餐服用或根據(jù)需要服用。圖14?建議使用益生菌（必要時(shí)添加消化酶）（8）補(bǔ)充必需氨基酸獲得足夠的蛋白質(zhì)并滿足您的氨基酸需求對(duì)于減少肌肉減少癥至關(guān)重要(7)（推薦每天1-2個(gè)雞蛋）。補(bǔ)充必需氨基酸可能會(huì)有幫助。我推薦AminoStrongEssentialAminoAcids。AminoStrong?代表了使用氨基酸合成肌肉蛋白質(zhì)的突破。已經(jīng)進(jìn)行了20多項(xiàng)人體試驗(yàn)，以得出這種特定的、正在申請(qǐng)專利的氨基酸組合，具有最有效的合成代謝比例。無論您是想增強(qiáng)肌肉力量和功能，還是想防止因缺乏運(yùn)動(dòng)或衰老而導(dǎo)致的肌肉流失，AminoStrong都能以正確的比例提供正確的氨基酸，幫助您實(shí)現(xiàn)目標(biāo)并保持健康。包含AminoStrong的氨基酸(AA)配方由國(guó)際公認(rèn)的肌肉代謝和衰老以及長(zhǎng)壽領(lǐng)域的研究人員精心開發(fā)和研究。AminoStrong專為尋求刺激肌肉蛋白質(zhì)合成、加速肌肉恢復(fù)以及促進(jìn)肌肉力量和功能的年輕人和老年人而設(shè)計(jì)。圖15?建議攝入優(yōu)質(zhì)必須氨基酸（多推薦：雞蛋、各種魚肉、牛肉）（9）考慮使用乳清蛋白獲得足夠的蛋白質(zhì)對(duì)于減少肌肉減少癥至關(guān)重要(7)。使用乳清蛋白可能會(huì)有所幫助（主要來源于雞蛋清）。我推薦乳清濃香草。強(qiáng)乳清粉是一種美味、高蛋白、低碳水化合物的功能性食品粉。它采用品質(zhì)卓越的乳清蛋白制成，這些乳清蛋白來自新西蘭無農(nóng)藥、非轉(zhuǎn)基因草場(chǎng)上放牧的奶牛，這里被認(rèn)為是世界上污染最少的環(huán)境之一。奶牛從不喂谷物，也沒有接受激素或抗生素治療。與其他速溶乳清配方不同，WheyStrong不含大豆。乳清蛋白由稱為氨基酸的單個(gè)“構(gòu)件”組成，用于制造酶、激素和抗體。乳清蛋白被認(rèn)為是一種完整的蛋白質(zhì)，因?yàn)樗凶銐虮壤乃斜匦璋被?，這些氨基酸是人體無法制造的，必須通過飲食獲得。它還富含半胱氨酸，有助于在體內(nèi)產(chǎn)生一種重要的抗氧化劑，即谷胱甘肽。乳清蛋白還含有大量支鏈氨基酸(BCAA)，尤其是亮氨酸。亮氨酸的重要作用是鍛煉肌肉。已發(fā)現(xiàn)乳清蛋白支持健康的身體成分。每天將30克（約一勺）混合在8盎司水或任何其他飲料中，或遵照保健醫(yī)生的指示。圖16?建議攝入乳清蛋白（主要來源于雞蛋清）小結(jié)肌肉減少癥是指與年齡相關(guān)的肌肉退化。肌肉質(zhì)量下降和肌肉減少癥可能會(huì)降低您參與日常任務(wù)和活動(dòng)的能力。它可能導(dǎo)致跌倒、受傷、住院、殘疾、喪失獨(dú)立性、護(hù)理和壽命縮短。幸運(yùn)的是，借助一些簡(jiǎn)單的自然策略，您可以自然地改善肌肉健康。建議您遵循我針對(duì)肌肉減少癥的自然支持策略，以隨著年齡的增長(zhǎng)保持肌肉質(zhì)量。（文中所涉及優(yōu)質(zhì)蛋白、氨基酸、乳清蛋白等，都可以在日常生活中食材中獲得，不推薦選擇進(jìn)口商品替代）WhatisSarcopeniaThewordsarcopeniameans“l(fā)ackofflesh”,whichmakessenseonceyouunderstandthecondition.Sarcopeniaisaconditionrelatedtoage-associatedmuscledegeneration.Itismorerelevantandmorecommoninthoseover50yearsofage.Aftertheageof30,peoplestartlosingtheirmusclestrength.Accordingtoa2004reviewpublishedinCurrentOpinioninClinicalNutritionandMetabolicCare,peopletendtolosebetween3to8percentoftheirmusclestrengtheachdecade(1).Losingmusclestrengthcanreduceyourabilitytoperformregulardailyactivitiesandroutinetasks.Itmayincreasetheriskofdevelopingadisability,losingindependence,andneedingcare.Itmayincreasetheriskoffalls,accidents,injuries,fractures,hospitalization,surgeries,andpost-surgerycomplications.Consideringthecostofhospitalizationandhomecare,sarcopeniacanalsobecomeverycostly.Accordingtoa2016reviewpublishedinWorldviewsonEvidence-BasedNursing,sarcopeniamayalsoshortenyourlifespan(2).Accordingtoa2015reviewpublishedinTheProceedingsoftheNutritionalSociety,sarcopeniamaydevelopbecauseoftheimbalancebetweenthesignalsformusclecellgrowth(anabolism)andsignalsforbreakdown(catabolism)(3).Inahealthybody,yourgrowthhormonesworktogetherwithprotein-destroyingenzymestokeepyourmuscleshealthyandmusclemasssteadythroughouttheongoingcycleofmusclegrowth,stress,injury,breakdown,destruction,repair,andrecovery.Inanagingbody,animbalancebetweensignalsandaresistancetogrowthsignalsmaydevelop,whichcancausemorecatabolismandmusclelossoveranabolismandmusclegrowth.SymptomsofSarcopeniaSymptomsofsarcopeniamayinclude:MuscleweaknessFallingSlowwalkingspeedSelf-reportedmusclewastingDifficultyperformingorpartakinginnormaldailytasksandactivitiesFatigueeasilyduringexertionRootCausesofSarcopeniaIfyouhaveanyhealthissues,it’simportanttolookattherootcausesoftheproblem.Ifwelookattherootcauseoftheproblem,wecandeveloptreatmentstrategiestoaddresstheminsteadofonlyputtingabandaidonthesymptoms.Therootcausesofsarcopeniamayinclude:InflammagingTheterminflammaging,alsoknownasinflamm-agingorinflamm-ageing,referstoanupregulatedinflammatoryresponseandalow-gradeinflammationthroughoutthebodythatdevelopswithadvancedage.Inflammagingcanacceleratetheagingprocessandmayworsensomeage-relatedsymptomsanddiseases.Accordingtoa2013studypublishedinLongevity&Healthspan,inflammagingmaybeaconsequenceoftheinnateandacquiredimmunesystemthatcanincreaseinflammatorycytokineproductioninthebody(4).Thiscanpromoteinflammationandcontributetoage-relatedhealthissues,includingmuscledecline.A2013studypublishedinThoraxhasfoundthatpatientswithchronicobstructivepulmonarydisease(COPD)andrelatedchronicinflammationalsohadadeclineinmusclemass(5).Therearemanyotherdiseasesthatarecharacterizedbylong-termchronicinflammation,includingchronicinfections,inflammatoryboweldiseases,andautoimmuneconditions,thatmayincreasetheriskofmusclelossandsarcopenia.Accordingtoa2016systematicreviewandmeta-analysispublishedinMaturitas,higherlevelsofC-reactiveproteinmaybeassociatedwithchronicinflammationandsarcopenia(6).InadequateProteinIntakeFollowinganunhealthydietlowinnutrientsandhighinrefinedsugar,refinedoil,artificialingredients,andoverlyprocessedfoodscanincreasechronicinflammation.Payingattentiontoyourmacronutrientsiscriticalaswell.Adiettoolowincaloriesandtoolowinproteincannotonlyresultinweightloss,butalsoinalossofmusclemass.Proteiniscriticalformusclehealth,musclemass,andmusclestrength.Aninadequateproteinintakemayleadtosarcopenia.Withaging,manypeopledevelopproblemswiththeirteethandgums,haveissuesswallowing,experiencechangesintheirtasteandappetite,andhaveincreasedchallengesshoppingandcooking.Thiscanincreasetheirriskofnotmeetingtheirproteinandcaloricneeds.Accordingtoa2015reviewpublishedintheJournalofClinicalMedicineResearch,consuming25to30gramsofproteinateachmealmayhelptolowertheriskofsarcopenia(7).PoorStomachAcidLevelsStomachacidisalsoknownasgastricacid.Itisawatery,colorlessfluidmadebyyourstomachliningtosupportdigestion.Asitsnamesuggests,stomachacidisveryacidic,whichsupportsthebreakdownoffoodforproperdigestion.Stomachacidalsohelpstheproperabsorptionofnutrients.?Poorstomachacidlevelscanclearlycauseproblemswhenitcomestodigestion.Ifyouhavepoorstomachacidlevels,yourbodymaynotbeabletobreakdownandabsorbproteinandothernutrientsfromfood.Thiscannotonlyleadtodigestiveissuesbutchronicinflammationandhealthcomplications.Accordingtoa2022studypublishedinNutrients,poorgastricmotilitymaybeassociatedwithsarcopeniainolderadults(8).A2019studypublishedinScienceReportshaslinkedgastroesophagealrefluxdisease,associatedwithlowstomachacidlevels,topoorskeletalmuscleattenuationandsarcopenia(9).GutDysbiosisYourgutishometotrillionsofbacteriaandmicrobes.Someofthesemicrobesarebeneficial,othersareharmfultoyourhealth.Thekeyistohaveagutmicrobiomeimbalance,whereyouhavemorebeneficialbacteriathanharmfulones.Unfortunately,aninflammatorydiet,poorlifestylechoices,nutrientimbalances,stress,environmentaltoxins,andotherfactorscandisruptthebalance.?Gutdysbiosismeansthatthereisanimbalanceinyourgutmicrobiome,andtherearetoomanyharmfulbacteriaandtoofewbeneficialones.Gutdysbiosiscancreatechronicinflammationandtheriskofchronicandserioushealthissues.Itmayalsoincreaseyourriskofsarcopenia.A2018studypublishedinMediatorsofInflammationhasfoundthatgutdysbiosismayplayaroleinage-relatedinflammation,inflammaging,muscleaging,andsarcopenia(10).Researchersfoundthattargetinggutdysbiosismaybeimportantwhenaddressingsarcopenia.A2021systematicreviewpublishedintheJournalofCachexia,Sarcopenia,andMusclehassupportedthesefindingsandhasfoundthatgutdysbiosismayplayacriticalroleinthedevelopmentofsarcopenia(11).ChronicStress&PoorSleepQualityChronicstressandpoorsleeparemajorunderlyingfactorsbehindchronicinflammation,inflammaging,andage-relatedhealthissues,includingsarcopenia.Accordingtoa2018studypublishedintheHormones,chronicstressmayplayaroleinbodycompositiondisorders,includingsarcopenia(12).Chronicandseriousstressrelatedtohealthissuesmayalsocontributetosarcopenia.Accordingtoa2015reviewpublishedintheProceedingsoftheNutritionalSociety,a2016reviewpublishedinCurrentGastroenterologyReports,a2016reviewpublishedinNephro-UrologyMonthly,anda2016reviewpublishedintheProceedingsoftheNutritionalSociety,stressrelatedtochronicliverdisease,chronicheartfailure,chronickidneydisease,andcancertreatmentmaycausemusclelossandsarcopenia(13,14,15,16).Chronicstresscancontributetopoorsleep.However,poorsleepcanalsocontributetochronicstress.Bothpoorsleepandchronicstresscanincreasechronicinflammation.AndchronicinflammationcancausepoorsleepandchronicstressThecycleofchronicstress,poorsleep,andchronicstresscanincreasetheriskofmuscleloss.?A2017cross-sectionalstudypublishedinMedicine(Baltimore)hasfoundalinkbetweensleepdurationandsarcopenia(17).Accordingtoa2019systematicreviewandmeta-analysispublishedintheJournalofClinicalMedicine,poorsleepqualitycannegativelyaffectsarcopenia(18).NaturalSupportStrategiesFortunately,withthehelpofsomesimpledietary,lifestyle,andsupplementstrategies,youcanimproveyourhealthnaturally.Irecommendthefollowingnaturalsupportstrategiesforsarcopenia:Anti-InflammatoryNutritionPlanChronicinflammationandinflammagingaresomeofthemainrootcausesofsarcopenia(4,5,6).Aninflammatorydietisoneofthemaindrivingfactorsofchronicinflammationandinflammaging.Consumingrefinedsugarandrefinedoilsdriveupinflammationandaccelerateinflammaging,whichmaycontributetosarcopenia.Accordingtoa2020studypublishedinNutritionJournal,thereisalinkbetweentheinflammatorypotentialofyourdietandtheriskofdevelopingsarcopenia(19).Irecommendremovingallrefinedsugarandcarbs,refinedoils,artificialingredients,deep-friedfoods,junkfoods,andoverlyprocessedfoods.Consumeadiethighinnutrientsandanti-inflammatorywholefoods.Eatplentyofgreens,vegetables,herbs,spices,sprouts,fermentedfood,lowglycemicindexfruits,grass-fedbeef,organmeat,pasture-raisedpoultryandeggs,grass-fedbutterandghee,wild-caughtfish,andwildgame.Eatorganicwheneverpossibleandavailable.OptimizeProteinIntakeInadequateproteinintakecancausemusclelossandincreaseyourriskofsarcopenia(7).Makesurethatwithinyournutrient-dense,anti-inflammatorydiet,yougetenoughproteinin.Aimfor0.5to1gramofproteinperpoundofbodyweight.Irecommendthatyoumainlyfocusonhealthyanimal-basedproteins,includinggrass-fedbeef,organmeat,pasture-raisedpoultryandeggs,wild-caughtfishandseafood,andwildgame.Ifyouhavedifficultymeetingyourproteinneedsthroughfood,youcanuseproteinpowderstohelpgetenoughprotein.Nutsandseedscanaddadditionalplant-basedproteintothemix.Idon’trecommendbeansandlentils,especiallynotinhigheramounts,astheycanbehighincarbohydratesandmaycausedigestivediscomfort.Irecommendavoidinggrainsduetotheirglutenandcarbohydratecontent.DoResistanceTraining?Inactivityandasedentarylifestylecanincreaseyourriskofmuscleweakness,muscleloss,andsarcopenia.Accordingtoa2015reviewpublishedintheJournalofClinicalDensitometry,notusingyourmusclesenoughisoneofthemaindrivingfactorsofsarcopenia(20).Accordingtoa2016reviewpublishedintheJournalofFrailtyandAging,bedrestandinactivityafteranillnessorinjurycancauserapidmusclelossinolderadults(21).?Decreasedmusclestrengthduetoinactivityandasedentarylifestylecanleadtofatigue,weakness,andpoorstrength,whichmaymakeexercisemoredifficultandmotivationtomovelow.Thiscanleadtoaviciouscycleofinactivity,muscleloss,andfatigue.Movingyourbodyregularlyand,moreimportantly,doingresistanceandstrengthtrainingworkoutsiscriticalforimprovingyourmusclestrength,mass,andhealthandreducingtheriskofsarcopenia.?Irecommendresistancetrainingatleast3to4daysaweek.Trycompoundmovementssuchassquats,deadlifts,pushpresses,rows,andsoon.Workingwithaphysicaltherapistortrainercanhelpyoulearntheproperform,trynewexercisessafely,andimproveyourstrengtheffectively.Thismaybeparticularlyimportantifyouarecomingbackfromaperiodofinjury,illness,orinactivity.It’salsoagreatoptionifyouarecompletelynewtoresistancetrainingandexercise.Time-RestrictedFeedingTime-restrictedfeedingorintermittentfastingmayalsohelpreducetheriskofsarcopenia.Accordingtoa2014studypublishedintheInternationalJournalofHealthSciences(Qassim),intermittentfastingmayreduceinflammationandtheriskofassociateddiseases(22).?A1988studypublishedintheJournalofClinicalInvestigationhasfoundthatintermittentfastingmayalsoimprovehumangrowthhormone(HGH)secretionandlevelscontributingtoimprovedmusclemass(23).Accordingtoa2019studypublishedinNutrients,intermittentfastingmayalsoimprovecollagenlevelssupportingjointandskinhealth(24).Irecommendpracticingtime-restrictedfeeding.Ideally,Irecommendeatingduringa6to10-houreatingwindowwitha14-18hourfastingwindow.Ifyouarenewtotime-restrictedfeeding,beginwitha12-hourovernightfast.Stopeatingafterdinneranddon’teatuntilbreakfastthenextday,12hourslater.Extendyourfastingwindowgraduallyuntilyoufindwhatworksforyou.Remembernottorestrictyourselfduringyoureatingwindow.Consumeanti-inflammatorywholefoodswithplentyofhealthyfats,enoughprotein,andlotsofmicronutrientstomeetyourcaloricandnutritionalneeds.ReduceStress&ImproveSleepQualityChronicstressandpoorsleepmayincreasetheriskofsarcopenia?(12,13,14,15,16,17,18).Reducingyourstresslevelsandimprovingyoursleepqualitymayhelp.Irecommendpracticingmeditation,breathwork,guidedrelaxationtechniques,prayer,andgratitudetoreduceyourstresslevelsandrespondtostressbetter.Journalingmayhelptoreleaseemotionalstressandspotnegativementalloopholes.Practicemindsetshiftsandpositiveaffirmation.Spendtimeinnature.Spendtimewithsupportivefriends,family,andcommunitymembers.Aimtoget7to9hoursofsleepanight.Gotobedandwakeuparoundthesametimetosupportyourcircadianrhythm.Avoidsugar,caffeine,heavyfood,ideallyallfood,alcohol,electronics,andstressatleasttwohoursbeforegoingtobed.Engageinrelaxingactivities,suchaspuzzles,journaling,reading,meditation,healingbaths,sippingonherbaltea,andcalmconversationsintheevening.Investinasupportivebed,supportiveandcomfortablemattress,pillows,andbedding,blackoutcurtains,andaneyemaskforbettersleep.ImproveStomachAcidLevelsPoorstomachacidlevelscanalsocontributetosarcopenia(8,9).Improvingyourstomachacidlevelsiscritical.UseLiquidNutritionThroughouttheDay:Trytomakesurethatatleasthalfofyourmealsareinaliquidform,suchasaproteinshakeorgreensmoothie.Proteinshakesarepre-metabolizedandveryeasytodigestanddonotdependuponHCLproduction.IfyouhavelowHCL,itmaybehelpfultodrinkonetotwoproteinshakesdailytosupportaminoacidabsorption,reduceextrastressonyourdigestion,andsupporthealthystomachacidlevels.UseGinger:Gingerisoneofthebestthingsforimprovingdigestivejuices.Irecommenddrinking2to3cupsofgingerteaeachday,youcanputgingeressentialoilinwater(2to3dropsin8ozofwater),?juicea?inchoffreshgingerrootinagreenjuiceeachday,andusegroundgingeronyourfoods.Youcanalsoaddfermentedgingertoyourdiet,whichiscommoninAsiandishessuchaskimchi.Sincespicyfoodscanbetriggeringforrefluxissues,makesurethatitisnottriggeringforyou.Ifitis,focusontheothersteps.SuperHydrateOutsideofMealTimes:Goodhydrationcanhelpactivatebowelmotilityandpushcontentsthroughthedigestivesystemwhichwillreducemicrobialfermentationandtoxicityinthebody.Thiscanhelptosupportyourstomachacidlevels.DrinkVeryLittleWithMeatContainingMeals:Whenyouareeatingmeatoranysortofheavierfood,youshouldstopdrinkingwaterorotherliquidsatleast30minutesbeforethemeal,exceptifyouneedtotakeasupplementwith2ouncesofwater.Holdingoffwaterduringthesemealswillreduceanypotentialdilutionofthegastricjuicesandallowforbetterdigestion.HoldOffOnWaterAfteraMeal:Toallowforoptimaldigestion,Ialsorecommendnotdrinkingwaterorotherliquidsuntilatleast30minutesafterameal.Thisallowsforproperstomachacidactivity,sterilization,andproteinmetabolism.UseLemonandAppleCiderVinegar:Squeezingfreshlemonorusinglemonjuiceorapplecidervinegaronyourmeatandvegetableshelpstopre-metabolizethefoodandsupportbetterdigestionandnutrientabsorption.YoucaneithermarinatefoodsinalemonorACVbaseorjustaddthemasadressingrightbeforeyouconsumethem.Again,makesurethatapplecidervinegarisnottriggeringanyrefluxsymptoms,focusonmyotherrecommendations.EatProteinFoodsattheBeginningoftheMeal:Thestomachwillbeginchurningoutitsstomachacidwhenyoubegineating,especiallywhenyouareconsumingprotein.Whileit’sculturallycommontoasaladbeforetheirproteindish,thisisnotgreatforyourHCLproduction.Itisamuchbetterideatoeatyourproteinwiththesaladorvegetablesinsteadofafter.UseFermentedVeggies:Fermentedfoodssuchassauerkraut,kimchi,pickles,pickledginger,andotherfermentedvegetablesallcontainorganicacids,enzymes,andprobioticswhichhelptoimprovedigestivejuicesecretions?Irecommendusingoneofthesewithallofyourheaviermealsandespeciallyanymealwithprotein.UseFermentedDrinks:Fermenteddrinkssuchasapplecidervinegar,coconutkefir,andkombuchaofferantimicrobialbenefitsandhelptoreducethebacterialload,especiallythebacteriainthestomachsuchasHPylori.KeepingHPylorilevelsdowniscriticalforthebodytobeabletoproduceenoughstomachacid.EatYourLargestMealWhenYouAreMostRelaxed:Yourbodyneedstoactivatetheparasympatheticnervoussystemtoproduceenoughstomachacids.Ifyouarebusyandonthego,youwillbeinfightorflightsympatheticmode.Ifyoustrugglewithlowstomachacid,thisfightorflightstateisnotgoingtoallowyourbodytoproduceanywherenearenough.Relaxingbeforethemealisimportanttoimprovestomachacidproduction.SupportOverallGutHealthandDigestion?Gutdysbiosisandpoorguthealthmayalsoincreaseyourriskofsarcopenia(10,11).Irecommendsupportingyouroverallguthealthanddigestion.A2021studypublishedintheFrontiersinNutritionhasfoundthattargetingagutmicrobiomewithprobioticsanddigestiveenzymesmaybehelpfulforsarcopenia(25).A2022studypublishedintheJournalofCachexia,Sarcopenia,andMusclehasfoundthatprobioticsupplementationmaysupportthegut-muscleaxisandmayreduceage-relatedsarcopenia(26).Accordingtoa2018reviewpublishedinCurrentOpinionsinClinicalNutritionandMetabolicCare,supportingproteindigestionmayhelptoreduceage-relatedsarcopenia(27).Eatplentyofprobiotic-richfoodsprobiotic-richfoodsincludingsauerkrauts,fermentedherbs,kimchi,kefir,kombucha,andyogurt.However,eatingprobiotic-richfoodsisnotenoughtosupportyourgutflora,especiallyifyouaredealingwithgutmicrobiomeimbalanceandallkindsofchronicguthealthissues.Probioticsmayhelptoimprovegutmicrobiomeimbalanceanddigestion.IrecommendusingProbiocharge100Billion.Tofurthersupportyourdigestion,Ialsorecommendtheuseofdigestiveenzymes.DigestiveenzymesmayhelptoreducesymptomsofdiarrheaandIBS,whichareoftenconnectedtobileacidmalabsorption.?IrecommendProteoEnzymestosupportproteinandoveralldigestion.ProteoEnzymes?affectcytokineandeicosanoidbalance,promotejointcomfortandsupportthebody’sabilitytomaintaintissueintegrity.?Italsohelpsbalancetheimmunesystem,reduceautoimmuneactivityandbreakdownpathogenicbiofilmsinthebody.ProteolyticenzymesinProteoEnzymesmaybreakdownproteinsandcomplexesthatcanbeproducedasaresultofinjuryandtissuedamage.Thisactivityisbelievedtoaidnutrientandoxygendeliveryandmayhelpspeedthebody’sabilitytorecoverandheal.Acid-resistantcapsulesfacilitatethesystemicdeliveryofenzymes.Takeitwitheachmealorasneeded.SupplementwithEssentialAminoAcids?Gettingadequateproteinandmeetingyouraminoacidneedsiscriticalforreducingsarcopenia(7).Supplementingwithessentialaminoacidsmayhelp.IrecommendAminoStrongEssentialAminoAcids.AminoStrong?representsabreakthroughintheuseofaminoacidsformuscleproteinsynthesis.Over20humantrialshavebeenconductedtoarriveatthisspecific,patent-pendingcombinationofaminoacidsinthemosteffectiveanabolicratios.Whetheryouwanttosupportmusclestrengthandfunctionorpreventmusclelossassociatedwithinactivityoraging,AminoStrongprovidestherightaminoacidsintherightratiostohelpyoumeetyourgoalsandstayhealthy.?Theaminoacid(AA)formulathatcomprisesAminoStrongwasmeticulouslydevelopedandstudiedbyinternationallyrecognizedresearchersinthefieldsofmusclemetabolismandaging,andlongevity.AminoStrongisdesignedforbothyoungandelderlyindividualswhoareseekingtostimulatemuscleproteinsynthesis,hastenmusclerecovery,andpromotemusclestrengthandfunction.ConsiderUsingWheyProtein?Gettingadequateproteiniscriticalforreducingsarcopenia(7).Usingwheyproteinmayhelp.IrecommendWheyStrongVanilla.WheyStrongisagreat-tasting,highprotein,lowcarbohydrate,functionalfoodpowder.Itismadewithanexceptionalqualitywheyproteinmadefromthemilkofcowsthatgrazeonpesticide-free,non-GMOgrasspasturesinNewZealand,whichareknowntobeoneoftheleastpollutedenvironmentsintheworld.Themilkingcowsareneverfedgrainandarenotsubjectedtohormoneorantibiotictreatments.Unlikeotherinstantizedwheyformulations,WheyStrongissoy-free.?Wheyproteinismadeupofindividual“buildingblocks”calledaminoacids,whichareusedtomanufactureenzymes,hormones,andantibodies.Wheyproteinisconsideredacompleteprotein,asitcontainsanadequateproportionofalltheessentialaminoacids,whicharethosethatcannotbemadebythebodyandmustbeobtainedthroughthediet.Itisalsorichincysteine,andithelpscreateanimportantantioxidantinthebody,whichisglutathione.Wheyproteinalsocontainsahighamountofbranched-chainaminoacids(BCAAs),especiallyleucine.Theimportantroleofleucineistobuildmuscles.Wheyproteinhasbeenfoundtosupporthealthybodycomposition.?Mix30grams(approximatelyonescoop)in8ouncesofwateroranyotherbeverageperdayorasdirectedbyyourhealthcarepractitioner.FinalThoughtsSarcopeniareferstoage-associatedmuscledegeneration.Losingmusclemassanddevelopingsarcopeniamaydecreaseyourabilitytoparticipateindailytasksandactivities.Itmayleadtofalls,injuries,hospitalization,disability,lossofindependence,care,andashorterlifespan.Fortunately,youcanimproveyourmusclehealthnaturallywiththehelpofsomesimplenaturalstrategies.Irecommendthatyoufollowmynaturalsupportstrategiesforsarcopeniatokeepyourmusclemassasyouage.Ifyouwanttoworkwithafunctionalhealthcoach,Irecommend?thisarticle?withtipsonhowtofindagreatcoach.?Ourwebsiteteamoffers?long-distance?functionalhealthcoachingprograms.Forfurthersupportwithyourbrainhealthandotherhealthgoals,justreachoutandourfantasticcoachesareheretosupportyourjourney.參考文獻(xiàn)SourcesinThisArticleInclude:1.VolpiE,NazemiR,FujitaS.Muscletissuechangeswithaging.CurrOpinClinNutrMetabCare.2004Jul;7(4):405-10.doi:10.1097/01.mco.0000134362.76653.b2.PMID:151924432.ChangSF,LinPL.SystematicLiteratureReviewandMeta-AnalysisoftheAssociationofSarcopeniaWithMortality.WorldviewsEvidBasedNurs.2016Apr;13(2):153-62.doi:10.1111/wvn.12147.Epub2016Feb4.PMID:268445383.MurtonAJ.Muscleproteinturnoverintheelderlyanditspotentialcontributiontothedevelopmentofsarcopenia.ProcNutrSoc.2015Nov;74(4):387-96.doi:10.1017/S0029665115000130.Epub2015Mar31.PMID:258266834.BaylisD,BartlettDB,PatelHP,RobertsHC.Understandinghowweage:insightsintoinflammaging.LongevHealthspan.2013May2;2(1):8.doi:10.1186/2046-2395-2-8.PMID:244720985.ConstantinD,MenonMK,Houchen-WolloffL,etalSkeletalmusclemolecularresponsestoresistancetraininganddietarysupplementationinCOPDThorax2013;68:625-633.LinkHere6.BanoG,TrevisanC,CarraroS,SolmiM,LuchiniC,StubbsB,ManzatoE,SergiG,VeroneseN.Inflammationandsarcopenia:Asystematicreviewandmeta-analysis.Maturitas.2017Feb;96:10-15.doi:10.1016/j.maturitas.2016.11.006.Epub2016Nov13.PMID:280415877.YanaiH.NutritionforSarcopenia.JClinMedRes.2015Dec;7(12):926-31.doi:10.14740/jocmr2361w.Epub2015Oct23.PMID:265664058.HuangHH,WangTY,YaoSF,LinPY,ChangJC,PengLN,ChenLK,YenDH.GastricMobilityandGastrointestinalHormonesinOlderPatientswithSarcopenia.Nutrients.2022Apr30;14(9):1897.doi:10.3390/nu14091897.PMID:355658649.Kim,Y.M.,Kim,JH.,Baik,S.J.etal.Associationbetweenskeletalmuscleattenuationandgastroesophagealrefluxdisease:Ahealthcheck-upcohortstudy.SciRep9,20102(2019).LinkHere10.PiccaA,FanelliF,CalvaniR,MulèG,PesceV,SistoA,PantanelliC,BernabeiR,LandiF,MarzettiE.GutDysbiosisandMuscleAging:SearchingforNovelTargetsagainstSarcopenia.MediatorsInflamm.2018Jan30;2018:7026198.doi:10.1155/2018/7026198.PMID:2968653311.LiuC,CheungWH,LiJ,ChowSK,YuJ,WongSH,IpM,SungJJY,WongRMY.Understandingthegutmicrobiotaandsarcopenia:asystematicreview.JCachexiaSarcopeniaMuscle.2021Dec;12(6):1393-1407.doi:10.1002/jcsm.12784.Epub2021Sep14.PMID:3452325012.Stefanaki,C.,Pervanidou,P.,Boschiero,D.etal.Chronicstressandbodycompositiondisorders:implicationsforhealthanddisease.Hormones17,33–43(2018).LinkHere13.vonHaehlingS.Thewastingcontinuuminheartfailure:fromsarcopeniatocachexia.ProcNutrSoc.2015Nov;74(4):367-77.doi:10.1017/S0029665115002438.Epub2015Aug12.PMID:2626458114.KappusMR,MendozaMS,NguyenD,MediciV,McClaveSA.SarcopeniainPatientswithChronicLiverDisease:CanItBeAlteredbyDietandExercise?CurrGastroenterolRep.2016Aug;18(8):43.doi:10.1007/s11894-016-0516-y.Erratumin:CurrGastroenterolRep.2016Nov;18(11):57.PMID:2737229115.HiraiK,OokawaraS,MorishitaY.SarcopeniaandPhysicalInactivityinPatientsWithChronicKidneyDisease.NephrourolMon.2016Apr26;8(3):e37443.doi:10.5812/numonthly.37443.PMID:2757075516.PradoCM,CushenSJ,OrssoCE,RyanAM.Sarcopeniaandcachexiaintheeraofobesity:clinicalandnutritionalimpact.ProcNutrSoc.2016May;75(2):188-98.doi:10.1017/S0029665115004279.Epub2016Jan8.PMID:2674321017.HuX,JiangJ,WangH,ZhangL,DongB,YangM.Associationbetweensleepdurationandsarcopeniaamongcommunity-dwellingolderadults:Across-sectionalstudy.Medicine(Baltimore).2017Mar;96(10):e6268.doi:10.1097/MD.0000000000006268.PMID:2827223818.Rubio-AriasJá,Rodríguez-FernándezR,AndreuL,Martínez-ArandaLM,Martínez-RodriguezA,Ramos-CampoDJ.EffectofSleepQualityonthePrevalenceofSarcopeniainOlderAdults:ASystematicReviewwithMeta-Analysis.JClinMed.2019Dec6;8(12):2156.doi:10.3390/jcm8122156.PMID:3181760319.Bagheri,A.,Soltani,S.,Hashemi,R.etal.Inflammatorypotentialofthedietandriskofsarcopeniaanditscomponents.NutrJ19,129(2020).LinkHere20.DoddsRM,RobertsHC,CooperC,SayerAA.TheEpidemiologyofSarcopenia.JClinDensitom.2015Oct-Dec;18(4):461-6.doi:10.1016/j.jocd.2015.04.012.Epub2015Jun12.PMID:2607342321.BellKE,vonAllmenMT,DevriesMC,PhillipsSM.MuscleDisuseasaPivotalProbleminSarcopenia-relatedMuscleLossandDysfunction.JFrailtyAging.2016;5(1):33-41.doi:10.14283/jfa.2016.78.PMID:2698036722.AlySM.Roleofintermittentfastingonimprovinghealthandreducingdiseases.IntJHealthSci(Qassim).2014Jul;8(3):V-VI.doi:10.12816/0023985.PMID:2550586823.HoKY,VeldhuisJD,JohnsonML,FurlanettoR,EvansWS,AlbertiKG,ThornerMO.Fastingenhancesgrowthhormonesecretionandamplifiesthecomplexrhythmsofgrowthhormonesecretioninman.JClinInvest.1988Apr;81(4):968-75.doi:10.1172/JCI113450.PMID:312742624.BragazziNL,SellamiM,SalemI,ConicR,KimakM,PigattoPDM,DamianiG.FastingandItsImpactonSkinAnatomy,Physiology,andPhysiopathology:AComprehensiveReviewoftheLiterature.Nutrients.2019Jan23;11(2):249.doi:10.3390/nu11020249.PMID:3067805325.Frontiersinnutrition2021.LinkHere26.ChenLH,ChangSS,ChangHY,WuCH,PanCH,ChangCC,ChanCH,HuangHY.Probioticsupplementationattenuatesage-relatedsarcopeniaviathegut-muscleaxisinSAMP8mice.JCachexiaSarcopeniaMuscle.2022Feb;13(1):515-531.doi:10.1002/jcsm.12849.Epub2021Nov11.PMID:3476647327.BoirieY,GuilletC.Fastdigestiveproteinsandsarcopeniaofaging.CurrOpinClinNutrMetabCare.2018Jan;21(1):37-41.doi:10.1097/MCO.0000000000000427.PMID:29028650https://drjockers.com/sarcopenia/感謝原文作者。2022年12月01日915
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劉衛(wèi)平主任醫(yī)師 北京腫瘤醫(yī)院 淋巴腫瘤內(nèi)科 那么另外就是，呃，關(guān)于骨的原發(fā)彌漫納B細(xì)胞淋巴瘤的預(yù)后啊，怎么樣?。科鋵?shí)呃，對(duì)于骨的原發(fā)的彌門納B細(xì)胞淋巴瘤，我們之前做過我們單中心的一個(gè)統(tǒng)計(jì)啊，發(fā)現(xiàn)其實(shí)它的整體的預(yù)后和淋巴結(jié)的，呃，病人的預(yù)后是差不多的啊，五年生存基本上也能到啊，70%左右啊，所以骨的，呃，原發(fā)的彌門大B細(xì)胞淋巴瘤，那么經(jīng)過規(guī)范的治療啊，預(yù)后相對(duì)來說都是比較好的。2022年09月28日83
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