As a retired physician, I notice many seniors become skinny and weak due to muscle loss yet have big bellies as fat accumulates. They are less strong, less vibrant, and prone to falls and chronic illnesses like heart disease, diabetes, and cognitive decline. This does not need to happen, but many older people do not appreciate the health and wellness impacts of muscle loss and reduced nutrient absorption, nor do they realize they can slow that process, feel better, be healthier, and live longer.

Muscle loss is a normal phenomenon of aging, and fat accumulation is common, but these are a deadly combination leading to many adverse outcomes like the ones noted above. They do not need to happen to you.

You can slow muscle mass and strength decline and even reverse it somewhat. In the process, you can lose some of that belly fat with resistance exercises and a proper diet.

To remain healthy, older people need not just aerobic but also muscle resistance exercises, more protein, fewer calories, and more micronutrients.

A natural decline that can be slowed

Beginning at about age 30, every organ and system in the body declines by about 1% per year. Sometimes more, sometimes less, and the rate varies from person to person. Most declines accelerate after the age of 70. Examples include loss of bone strength, balance, immune function, and cognition.

Your muscle mass and strength also decline. Initially, the decline is about 1 percent per year but speeds up in the 70s and 80s. Suddenly, you notice that you are skinny even though your belly is enlarging. This change creates multiple problems — less strength and balance to prevent falls, less muscle tissue for metabolism, worse immune function, and a reduction of critical chemicals released, such as one that slows brain decline.

“Even if this natural decline is somehow unavoidable, opportunities exist to slow down and attenuate the impact of advancing age on major physiological processes which, when weakened, constitute the hallmarks of aging,” several experts concluded in a 2023 expert review of the aging process.

The key to combatting these declines is modifying lifestyles, especially by exercising and eating better.

Many, if not most seniors, although not pleased to see their muscles “wilt away,” assume this is just part of aging and nothing can be done. Likewise, many don’t appreciate that they should reduce their caloric intake to avoid gaining fat weight. They also are unaware of the need for more fruits and vegetables and do not realize that a good program of aerobic and resistance exercises will slow and even reverse the process of muscle loss and belly fat gain.

We also lose digestive functions over our adult lifetime. There is less saliva with its enzymes that start the digestive process, the stomach provides less acid to break down foods, and the intestines and pancreas manufacture fewer enzymes. Thus, the digestive process is slower and less effective, and the intestinal lining cells absorb nutrients less efficiently. The result is lessened absorption of micronutrients such as vitamins, minerals, polyphenols, and flavonoids.

A seeming paradox

With less muscle mass accentuated by a sedentary lifestyle, we seniors need fewer calories, yet we need to consume more foods containing micronutrients to offset the reduced absorption. What more often happens, not understanding the aging process, is we continue to eat the same foods in the same amounts as we always have. As muscles diminish in size and strength, our bellies gain fat, while critical metabolic functions are starved of micronutrients.

For example, suppose a person in their 60s usually ate 1,800 calories per day and, given their activity level, that kept their weight stable. But in the mid-70s and beyond, less muscle mass and less physical activity would mean they need less calories, say, 1,500 per day. Those unnecessary extra 300 calories per day will produce fat that will accumulate in the belly. This fat is metabolically active and releases chemicals that lead to inflammation in the coronary arteries, the brain, joints, and many other locales. And if the opportunity is there to eat dessert every night with its high calories but minimal micronutrients, all the more fat will accumulate.

Here are some of the critical nutrients that older people tend to consume too little: vitamin B12, folic acid, calcium, potassium, fiber, and omega-3 fatty acids. Studies also indicate that many seniors get too few polyphenols and flavonoids, these being important to prevent a variety of chronic illnesses such as heart disease, neurodegenerative diseases, and cancer.

“There is evidence that micronutrient insufficiencies are linked to multiple age-related chronic diseases, including cancer, osteoporosis, and heart disease,” according to the Dietary Guidelines Committee of the National Academy of Sports Medicine (NASM).

Americans get most of their calories from “grain-based desserts, bread, chicken and chicken mixed dishes, soda, and pizza, and alcohol,” the NASM states. Few items here have extensive micronutrients, but many are high in sugar and white flour, which digests to sugar. Remember that alcohol carries a lot of calories.

Muscles need the amino acids in proteins to develop. This means increasing the usual adult recommendation of 56 grams of protein daily for men and 46 for women to about 100g or even more. In visual terms, 3 ounces (like a deck of cards) of chicken is 27grams of protein, 3 oz of lean beef is 23 gm, 3 oz of salmon is 19 gm, 1 egg is 6 gms, and 3 oz of Greek yogurt is 9 gm.

A reasonable regimen to consider

The answer to the paradox is to get more exercise, especially resistance exercise, cut calories, and increase your protein, vegetables, and fruit intake.

It is possible to slow the rate of muscle mass decline and even regain muscle mass and strength with an exercise program that includes both aerobic and extensive resistance exercises and an appropriate diet. Take a 30-minute brisk walk at least six days per week. Do resistance (weights) exercises at least two, preferably three, days per week. These can be done at home with no equipment. For example, try the plank, side plank, bird dog, and crunches for your core, pushups for your core and upper body, and squats for your lower body. Working with a personal trainer in a gym for a month or two to devise the best exercises for you and help you use the correct form is very worthwhile and serves as a reminder to actually do the exercises.

It takes greater effort to build muscle in later years. It likely will take a few months or more of regular resistance exercise to see substantial muscle gain, much different than when you were younger. But persistence will win the day.

Follow the Mediterranean or MIND style diet, emphasizing extensive fruits, vegetables, whole grains, nuts, seeds, beans, olives, and olive oil. Add to these regular meals of fin fish, eggs, poultry, and occasionally red meat from grass-fed animals.

Avoid foods with lots of sugar and foods made from white flour; unfortunately, this means many of our favorite snacks, like candy, pastries, donuts, cakes, and pies. Be aware that nonfat Greek yogurt, with its high protein content, is very healthy, but when flavored or containing fruit, it almost always has added sugars. Enjoy some wine, but don’t refill that glass multiple times.

Eliminate or cut way back on sugary drinks, ultra-processed foods (e.g., Little Debbie, Cheetos, Doritos, and the like), and most fast foods since they contain far too many useless calories and few of those micronutrients. Have you ever found a fruit or a veggie other than a pickle with your burger and fries? Ketchup doesn’t count as a tomato.

To add some specificity, kale, spinach, broccoli, bell peppers, brussels sprouts, sweet potatoes, beets, blueberries, salmon, quinoa, and kiwi have a high nutrient-to-calorie ratio, i.e., they are low in calories but high in micronutrients. Consider eating lots of berries — blueberries, blackberries, and strawberries, with their high concentrations of vitamins, minerals, polyphenols, and flavonoids, along with other fruits like apples, pears, citrus, peaches, and apricots.

Supplements should be just that: supplements to healthy foods. However, do consider taking a multivitamin and, if your doctor advises, vitamin D (as D3). Seniors often take multiple medications and have one or more chronic illnesses, so be sure to discuss your eating and exercise program with your primary care physician before starting.

Although I have focused on exercise and food, don’t forget to get a good night’s sleep, manage your stresses, avoid tobacco, and keep alcohol limited.

It behooves us as older individuals to eat fewer calories but more protein, more fruits, and veggies, and do resistance exercises. Let this article be a “nudge.” Remember, “It Is Never Too Late” to modify your lifestyles. You will feel better, be healthier, and live longer — an increased health span.

Stephen C. Schimpff is an internal medicine physician.