Deep dive: Sarcopenia and Herbal Medicine

Here are some snippets (!) from my final year research project in 2025 “Scoping Review to Identify What Evidence There is That Herbs Commonly Used in Western Herbal Medicine Can Improve Skeletal Muscle Health in Aging”. If you want more information on this topic or about my research methods then please get in touch.

What is Sarcopenia?

Sarcopenia is a natural part of aging leading to loss of muscle mass and function. Sarcopenia impacts physical functionality and can progress to frailty; frailty can decrease both quality of life and life expectancy.

To keep things simple, I will be referring to sarcopenia as muscle loss in this article, to keep things simplified.

Loss of muscle mass can start as early as your 30’s and although research is ongoing into pharmaceutical treatments currently, there are none to prevent sarcopenia.

It is estimated that lean muscle mass loss is between 1% and 2% per year after age 50, and strength loss is between 1.5% and 5% [1].

This loss of mass and function is typically due to biochemical changes in your body: increased protein degradation (more of your proteins are broken down – less protein available for building muscle) and decreased protein synthesis (less protein made). But also, lifestyle factors such as reduced physical activity, and an increase in adipose tissue (fatty tissue) [2].

Remaining physically active, resistance exercise and nutrition are often seen as the main treatment and advice for muscle loss [3]. However, this has its limitations, there is often confusing and contradicting information about the amount (how often and how much) and type (resistance or cardiovascular training) of physical exercise we should be doing to reduce muscle loss and how much protein we should be eating.

The science bit…

Whilst lifestyle factors play a part there are also many biochemical factors involved in muscle loss, including but not limited to:

• Proteostasis – the quality control of proteins; including protein repair and protein turnover (the balance of protein synthesis and degradation) [4]

• Mitochondrial dysfunction – the processes involved in the quality control of mitochondria, which, when dysfunctional, can lead to an accumulation of reactive oxygen species (ROS) which can promote protein degradation and inhibit protein muscle synthesis [5] (mitochondria are the powerhouses of your cells, producing cellular energy)

• Cellular signalling – the balance of transcription factors and signal transducers that influence gene expression, protein degradation, reduced protein synthesis, cellular apoptosis and pro-inflammatory cytokines [6,7]

• Satellite cell differentiation and regeneration - declines with disuse and aging, reducing the size and number of muscle fibres [8,9]

• Endocrine imbalances - aging hormone changes (oestrogens and androgens) insulin resistance and a reduction in growth hormones [10]

There are limited human clinical trials on herbal medicine – for lots of reasons (see my upcoming notebook post on that). Most of the research discussed in this article is done in the lab (in vitro), but we can compare this with the long-standing traditional use of herbs and see that some herbs may be beneficial.

Shatavari [Asparagus racemosus Willd]

There is a long history of shatavari use for improving stamina [11], and as a preventative against aging [12]. It is known as “she who has a hundred husbands” in Sanskrit, [13]. A study in 2025 indicated that oxidative stress and reduced oestrogen levels in older women could be improved by shatavari phytoestrogenic action [14]. A study in 2021 reported that shatavari increased hand grip strength [15].

Schisandra [Schisandra chinensis (Turcz.) Baill]

Schisandra is known as a liver tonic, however it is also used as a women’s herb, helping with menopausal symptoms such as hot sweats and also for stamina and improving athletic performance [11,12]. A 2020 study on schisandra found quadriceps (thigh) muscle strength increased (but hand grip strength wasn’t) [16].

Horsetail [Equisetum arvense L]

The herbalist John Parkinson (1567 to 1650) wrote of horsetail as a healing herb for children and the elderly [17]. Horsetail is used in herbal medicine for connective tissue repair (bones, tendons, and ligaments) due to its high content of silica. Research in 2024 identified the constituents’ quercetin and apigenin which may reduce ‘inflammation induced muscle atrophy’ and increase a biochemical pathway which promotes protein synthesis and inhibit protein degradation [18].

Tonic and longevity herbs

Milkvetch [Astragalus mongholicus Bunge] is a Traditional Chinese Medicine (TCM) tonic herb for fatigue, longevity and to increase vitality and endurance [19]. A 2020 study found that milkvetch may supress a protein which marks other proteins for degradation [20].

Ashwagandha [Withania somnifera (L.) Dunal], turmeric [Curcuma longa L.] and fenugreek [Trigonella foenum-graecum L] are all classed as tonic herbs in Ayurveda [13].

Ashwagandha is known for its action of rejuvenation on the muscles, in managing stress and improving resilience [13]. Turmeric is a well-known anti-inflammatory [13] and fenugreek can support in diabetes and high cholesterol as well as supporting aging in males [21].

Herbs with “tonic” actions are thought to have an anabolic action (building up, growing muscle, tissue repair) and are often used for supporting health in aging.

In a nutshell

To help reduce muscle loss, we need to be physically active, building muscle through resistance training, eating enough protein, and managing our stress (which plays a part in inflammation).

At times of stress, different life stages and in aging, our bodies need support to maintain the delicate balance of biochemical processes.

Herbal medicine can support you in reducing inflammation, reducing stress (helping you get better sleep, reducing anxiety and improving mood), balancing hormones, improving digestion (so the nutrients in the food you eat are more readily available and your body can effectively eliminate what it doesn’t need), managing pain and help with metabolic and cardiovascular health.

A full herbal medicine consultation can tailor a blend of herbs unique to you and is based on your own requirements, including checking for any potential interactions there may be with any prescribed medicine you are taking.

We have a wealth of herbs waiting to help you feel better at whatever stage of life you are at.

References

1.          Keller, K., & Engelhardt, M. (2014). Strength and muscle mass loss with aging process. Age and strength loss. Muscles, Ligaments and Tendons Journal, 3(4), 346–350. PMID: 24596700

2.          Moore, D. R. (2014). Keeping older muscle “young” through dietary protein and physical activity. Advances in Nutrition, 5(5), 599S-607S. https://doi.org/10.3945/an.113.005405

3.          Dent, E., Morley, J. E., Cruz-Jentoft, A. J., et al. (2018). International clinical practice guidelines for sarcopenia (ICFSR): Screening, diagnosis and management. The Journal of Nutrition, Health and Aging, 22(10), 1148–1161. https://doi.org/10.1007/s12603-018-1139-9

4.         Fernando, R., Drescher, C., Nowotny, K., et al. (2019). Impaired proteostasis during skeletal muscle aging. Free Radical Biology and Medicine, 132, 58–66. https://doi.org/10.1016/j.freeradbiomed.2018.08.037

5.          Lei, Y., Gan, M., Qiu, Y., et al. (2024). The role of mitochondrial dynamics and mitophagy in skeletal muscle atrophy: From molecular mechanisms to therapeutic insights. Cellular & Molecular Biology Letters, 29, 59. https://doi.org/10.1186/s11658-024-00572-y

6.         Ebert, S. M., Al-Zougbi, A., Bodine, S. C., et al. (2019). Skeletal muscle atrophy: Discovery of mechanisms and potential therapies. Physiology, 34(4), 232–239. https://doi.org/10.1152/physiol.00003.2019

7.          Jackman, R. W., & Kandarian, S. C. (2004). The molecular basis of skeletal muscle atrophy. American Journal of Physiology-Cell Physiology, 287(4), C834–C843. https://doi.org/10.1152/ajpcell.00579.2003

8.          Frontera, W. R., Hughes, V. A., Fielding, R. A., et al. (2000). Aging of skeletal muscle: A 12-yr longitudinal study. Journal of Applied Physiology, 88(4), 1321–1326. https://doi.org/10.1152/jappl.2000.88.4.1321

9.          Johnson, A. L., Kamal, M., & Parise, G. (2023). The Role of Supporting Cell Populations in Satellite Cell Mediated Muscle Repair. Cells, 12(15), 1968. https://doi.org/10.3390/cells12151968

10.        Rolland, Y., Czerwinski, S., Van Kan, G. A., et al. (2008). Sarcopenia: Its assessment, aetiology, pathogenesis, consequences and future perspectives. The Journal of Nutrition, Health & Aging, 12(7), 433–450. https://doi.org/10.1007/BF02982704

11.         Chevallier, A. (2016). Encyclopedia of herbal medicine: 550 herbs and remedies for common ailments (3rd ed.). Dorling Kindersley.

12.         Winston, D., & Maimes, S. (2019). Adaptogens: Herbs for strength, stamina, and stress relief. Healing Arts Press.

13.         Lad, V., & Frawley, D. (2010). The yoga of herbs: An Ayurvedic guide to herbal medicine. Motilal Banarsidass.

14.        Greed, E., Pritchard, J., Struszczak, L., et al. (2025). Shatavari supplementation during eight weeks of resistance training increases training load, enhances skeletal muscle contractility and alters the skeletal muscle proteome in older women. Frontiers in Nutrition, 11, 1498674. https://doi.org/10.3389/fnut.2024.1498674

15.         O’Leary, M. F., Jackman, S. R., Sabou, V. R., et al. (2021). Shatavari supplementation in postmenopausal women improves handgrip strength and increases vastus lateralis myosin regulatory light chain phosphorylation but does not alter markers of bone turnover. Nutrients, 13(12), 4282. https://doi.org/10.3390/nu13124282

16.         Park, J., Han, S., & Park, H. (2020). Effect of Schisandra chinensis extract supplementation on quadriceps muscle strength and fatigue in adult women: A randomized, double-blind, placebo-controlled trial. International Journal of Environmental Research and Public Health, 17(7), 2475. https://doi.org/10.3390/ijerph17072475

17.         Bruton-Seal, J., & Seal, M. (Eds.). (2014). The herbalist’s bible: John Parkinson’s lost classic rediscovered; Theatrum botanicum (1640). Merlin Unwin Books.

18.         Salvadori, L., Paiella, M., Castiglioni, B., et al. (2024). Equisetum arvense standardized dried extract hinders age-related Osteosarcopenia. Biomedicine & Pharmacotherapy, 174, 116517. https://doi.org/10.1016/j.biopha.2024.116517

19.        Lord, R. (2022). Clinical herbalism: Plant wisdom from east and west. Elsevier.

20.       Nozaki, R., Hung, Y.-L., Takagi, K., et al. (2020). Differential protective effects of Radix astragali, herbal medicine, on immobilization-induced atrophy of slow-twitch and fast-twitch muscles. Biomedical Research (Tokyo, Japan), 41(3), 139–148. https://doi.org/10.2220/biomedres.41.139

21.         Rao, A., Steels, E., Inder, W. J., et al. (2016). Testofen, a specialised Trigonella foenum-graecum seed extract reduces age-related symptoms of androgen decrease, increases testosterone levels and improves sexual function in healthy aging males in a double-blind randomised clinical study. The aging male: the official journal of the International Society for the Study of the Aging Male, 19(2), 134–142. https://doi.org/10.3109/13685538.2015.1135323