Sarcopenia: muscle loss in older adults, how much protein over-60s need, and whether creatine helps

What sarcopenia is

Sarcopenia is muscle loss that has gone far enough to affect strength and everyday life. The European working group on sarcopenia (EWGSOP2, 2019) calls it a muscle disease, built up over a lifetime. It puts strength first, because weak muscles predict falls and loss of independence better than muscle size does.

Diagnosis goes in steps:

• probable sarcopenia – low muscle strength (weak grip or slow chair rises);
• confirmed – a scan, such as DXA or bioimpedance, also shows low muscle mass;
• severe – walking speed or other physical performance is low as well.

Warning signs that should prompt a check: falls, feeling weaker, walking more slowly, or losing weight without trying. International guidelines (ICFSR) suggest screening with walking speed or the short SARC-F questionnaire, which your GP can run.

A check you can do at home. Sit on a firm dining chair with your arms crossed over your chest. Time how long it takes to stand up fully and sit down 5 times. Have someone nearby in case you lose balance. If it takes longer than 15 seconds, mention it at your next GP appointment.

Resistance exercise comes first

International ICFSR guidelines strongly recommend resistance training as the first treatment for sarcopenia. Protein is only a conditional recommendation. Supplements are there to help muscles respond to training, not to replace it.

The NHS advises adults over 65 to:

• do something active every day, even if it’s light;
• do activities that build strength, balance and flexibility on at least 2 days a week;
• build up to 150 minutes of moderate activity a week;
• break up long spells of sitting.

Strength work doesn’t need a gym. Standing up from a chair without using your arms, wall press-ups, a resistance band, carrying shopping and climbing stairs all count. If you have heart disease, osteoporosis or recent falls, ask your GP or a physiotherapist where to start. Our page on bone health and falls covers balance programmes.

How much protein do over-60s need?

Two expert groups have set targets for older people:

• PROT-AGE (2013): at least 1.0–1.2 g of protein per kg of body weight a day for over-65s; 1.2–1.5 g/kg with an acute or long-term illness; at least 1.2 g/kg for people who exercise.
• ESPEN (2019): at least 1 g/kg a day, adjusted for health, activity and appetite.

That’s more than the 0.75 g/kg often quoted for adults in general, so many older people need more protein than they think.

Work out your own number:

Protein is easiest to reach when every meal includes a protein food: eggs or yoghurt at breakfast, fish, chicken or beans at lunch, meat, lentils or cheese in the evening. PROT-AGE found the evidence on timing too thin for firm rules, so spreading it out is about practicality.

If your appetite is small, a protein powder helps. Unflavoured whey or milk protein can go into porridge, soup or mashed potato without changing the taste much.

Creatine for older adults

Creatine has the best evidence of any supplement here, but only together with training. A 2017 meta-analysis pooled 22 randomised trials with 721 participants, average age 57–70. Compared with placebo, creatine plus resistance training added about 1.37 kg of lean mass and more strength in both chest press and leg press.

Older adults take the same dose as younger ones: 3–5 g of creatine monohydrate a day, every day. Our creatine monohydrate guide covers loading, side effects and the water weight. Two points matter more after 60:

1. Ask your GP to check your kidney function before you start.
2. Creatine raises creatinine in the blood, so tell your doctor you take it before a kidney blood test.

Vitamin D, HMB and leucine

Vitamin D. The ICFSR guidelines give no recommendation for vitamin D to treat sarcopenia. Take the standard NHS dose of 10 mcg (400 IU) for bones and general health, and more only if a blood test shows you’re low. See our guide to vitamin D3 tablets.

HMB (beta-hydroxy-beta-methylbutyrate, made from the amino acid leucine). A 2021 meta-analysis of 9 trials with 448 older adults found more fat-free mass with HMB. But when HMB was added to exercise, it made no extra difference. The trials were small.

Leucine is an amino acid found in protein foods, especially dairy. Guidelines don’t recommend separate leucine capsules: ICFSR found too little good evidence for treatments beyond exercise and protein.

Kidney disease and high protein

High-protein advice has one big exception. PROT-AGE excludes people with severe kidney disease (eGFR below 30) who are not on dialysis: they may need to limit protein. The 2024 KDIGO kidney guideline also warns against high protein intake in kidney disease that is getting worse, while noting that frail older people may need more.

This is a balance only your kidney team can strike. If you have chronic kidney disease, don’t raise your protein, start a protein powder or take creatine without asking them. Our page on supplements with kidney disease explains why.

Where to start

A simple order of steps, using only the advice above:

Who should be careful

• Chronic kidney disease: protein targets and creatine only via your kidney team.
• Heart disease, recent falls or osteoporosis: ask about safe exercises first.
• Unexplained weight loss or weakness: see your GP before buying supplements.
• Several medicines: bring a list to your appointment; our medicines list for your GP makes it easy.

How to choose protein and creatine on iHerb

1. Start with food. Add a powder only if you can’t reach your target.
2. Choose an unflavoured powder with no added sugar so it mixes into ordinary meals.
3. Compare grams of protein per scoop, not scoop size.
4. For creatine, buy plain creatine monohydrate.
5. Check your kidney function before you start creatine or a high-protein diet.

More on this age group is in our 50+ section, and our vitamin check has answers for 51–64 and 65+.