The common occurrence that’s as deadly as any chronic disease

Here’s how to minimize your risk

My top priority is to help you live longer by giving you all the information you need to prevent and reverse chronic disease—whether it’s diabetes, cancer, or heart disease. But there’s one major cause of death that isn’t actually a chronic disease at all…

Fact: One out of every four Americans over the age of 65 falls in any given year. And every 20 minutes, an older adult will die because of it.

Yes, you read that right.

Falls are the leading cause of fatal injury in this population. They’re responsible for more than 800,000 hospitalizations, and upwards of 30,000 deaths annually. To make matters worse, recent research shows that they’re happening to more people—more often than ever before.

Falls are on the rise—but not just in the elderly

Researchers recently looked at fall trends among middle-aged and older adult participants of the National Institute of Aging’s Health and Retirement Study.

In this study, “falling” constituted at least one self-reported fall over the last two years. And results showed that these falls rose from roughly 28 percent in 1998 to 36 percent in 2010.1

We’re talking about a 30 percent increase here. And it’s not just the elderly who faced this elevated risk. Researchers identified these increases across all age groups. And this isn’t the only study to discover this trend among younger adults.

In fact, another recent report found that fall rates among European women have increased by nearly:

  • 10 percent in 40- to 44-year-olds
  • 20 percent in 45- to 49-year-olds
  • 21 percent in 50- to 54-year-olds
  • 30 percent in 55- to 65-year-olds2

These findings suggest that efforts to prevent falls need to start a lot earlier than retirement age. And you know what? I couldn’t agree more.

Because just like chronic disease, the problems that precede increased fall risk begin decades before the real trouble sets in.

Why the fight against falls starts in mid-life

Sarcopenia is the earliest factor behind elevated fall risk.

As you may recall, it’s just a fancy term for the progressive muscle loss that accompanies aging. But these declines in muscle mass strike earlier than you might expect.

Yes, the elderly are at the highest risk for the condition—but only because they have more years of muscle loss under their belts. The scary truth is, muscle mass starts taking a nosedive as soon as you hit 30.

So if you haven’t taken measures to prevent major losses by the time you’re 70, you could be struggling daily with the fallout (emphasis on the “fall”).

Research clearly shows that older patients with sarcopenia—and related “dysmobility syndrome,” which includes issues like slow walking speed—are at a significantly higher risk of both falling and fractures.3

Yet we tend to dismiss sarcopenia as a “normal” part of aging. That’s only our first mistake. When sarcopenia is paired with obesity—which is the case with around half of all older adults—things get especially dangerous.

This deadly combo is called “sarcopenic obesity.” And research shows it’s one of the straightest paths to falls, leading to fracture and disability.

Sarcopenic obesity strikes early

A recent study focused on fall risk among older women. Researchers reviewed data from more than 11,000 postmenopausal participants in the Women’s Health Initiative (WHI)—including weight, muscle mass, and fall history.

Ultimately, researchers found that sarcopenic obesity posed the greatest fall risk to postmenopausal Hispanic/Latina women. But they also linked the condition to a higher risk of falls in all postmenopausal women younger than 65.4

Needless to say, these aren’t the women you’d expect to be taking catastrophic tumbles. (And given the sharp declines in bone density that often accompany menopause, catastrophe is practically guaranteed.)

Of course, the real tragedy here is that, despite its reputation as an inevitable part of aging, sarcopenia is just as preventable as obesity.

At the most basic level, sarcopenia is just another byproduct of “sitting disease”—a modern plague that ages you from the inside out. In fact, a sedentary lifestyle can rob up to 5 percent of your muscle mass every year. But it doesn’t take much to fight back against this risk…

As usual, exercise is key

One of the most important things you can do to avoid this debilitating trifecta of sarcopenia, obesity, and falls is to get moving.

I know I always harp on the importance of exercise. But it really is critical. And a new clinical trial published in the Journal of the American Medical Association underscores why.  

This study looked at nearly 350 adults over the age of 70—all with an average of three prior falls, and generally limited mobility and frailty. Researchers tasked them with simple in-home strength and balance exercises—using basic equipment like free weights—at least three times a week.

Researchers found that seniors who stuck with the program for 12 months reduced their risk of future falls by an impressive 36 percent.5 They also improved cognitive function markers—another major factor behind fall risk.

In fact, Alzheimer’s disease actually doubles your risk of falls. And every year, upwards of 60 percent of dementia patients will take a spill. Luckily, research shows that regular exercise dramatically reduces falling in this population, too.6

And it doesn’t take much to make a difference. Obviously, strength training is important for preserving muscle mass at any age. But studies indicate that even the gentlest movement can have a major impact on fall risk.

A recent review of 35 different studies of English, Chinese, and Korean populations looked specifically at the benefits of Tai Chi—a practice that combines deep breathing and relaxation with gentle movement to increase balance, strength, and mental health. 7

One 12-week trial included in the review showed that stroke survivors who practiced Tai Chi experienced the fewest falls.8 (This is important because stroke survivors are actually seven times more likely to fall than their healthy peers.)

And a study of older adults in Oregon—all of whom took one-hour Tai Chi classes, twice weekly, at their local senior centers for 12 weeks—also showed dramatic improvements in balance, fall rates, and functional independence.9 No fancy equipment necessary.

At the end of the day, consistency is still key. So whether it’s Tai Chi or a simple daily walk, just be sure you’re getting 150 minutes of moderate exercise weekly to reap the rewards.

But of course, exercise is just part of the equation…

Protein matters more than people think

As you may recall, the “A” in my A-List Diet stands for amino acids, which your body needs to do virtually everything. But chief among these biological tasks is building muscle.

This is important because most seniors aren’t getting the protein they need to maintain and build muscle.

For years, the medical establishment has been telling us to cut down on protein intake—and I have no doubt that this terrible advice is the primary contributing factor behind the rise in sarcopenia.

In fact, the Recommended Dietary Allowance (RDA) for protein is a paltry 7 ounces of meat per day for the average 130-pound woman. But research consistently shows that the daily dose of protein should be at least double this amount, if the goal is to improve muscle mass and reduce frailty and weakness.10

I’ve written about my protein recommendations a number of times before. But here’s a quick refresher: Eat your body weight in grams of protein on the days you’re not exercising. And eat 1.5 times your body weight on the days that you are.

Now, I realize that may sound daunting. But if you include protein with every meal (in the form of eggs, nuts, and/or meat), you shouldn’t have too much trouble reaching this goal.

You can even add a whey protein shake to your routine once or twice daily. But if you’re still having trouble incorporating enough protein into your daily diet, order yourself a copy of The A-List Diet for further guidance. Because research shows that eating enough protein can work real miracles for your muscles.

The most important nutrient in your anti-fall arsenal

In addition to upping your protein intake, plenty of research has shown that supplemental vitamin D can reduce the risk of falling among older adults.

In fact, as part of a recent pilot study, researchers set out to assess the benefit of including vitamin D supplements—at a dose of 100,000 IU per month, or just over 3,300 IU per day—as part of a Meals-on-Wheels program.

Testing showed that more than half of the senior subjects were deficient in vitamin D, while fewer than a quarter met the conventional sufficiency threshold of 30 ng/mL or higher.

Monthly supplementation effectively increased these concentrations in nearly all subjects. But more importantly, the seniors taking vitamin D reported half the amount of falls compared to controls who didn’t supplement.12

Clearly, diet and exercise are key in this fight. But I can never stress the importance of vitamin D enough. Make sure your doctor is checking your vitamin D blood levels regularly. The threshold for sufficiency may be 30 ng/mL, but for optimal health, you need to aim closer to 80 ng/mL.

Proper supplementation will help you achieve these levels. I recommend at least 2,000 to 5,000 IU of vitamin D3 daily, but I’ve also found that higher doses, up to 10,000 IU per day (which is what I take) are often necessary—especially in the winter, when sunlight is fleeting.


  1. Cigolle CT, et al. “The epidemiologic data on falls, 1998-2010: more older Americans report falling.” JAMA Intern Med. 2015 Mar;175(3):443-5.
  2. Peeters G, et al. “Should prevention of falls start earlier? Co-ordinated analyses of harmonised data on falls in middle-aged adults across four population-based cohort studies.” PLoS One. 2018 Aug 7;13(8):e0201989.
  3. Clynes MA, et al. “Definitions of Sarcopenia: Associations with Previous Falls and Fracture in a Population Sample.” Calcif Tissue Int. 2015 Nov;97(5):445-52.
  4. Follis S, et al. “Association Between Sarcopenic Obesity and Falls in a Multiethnic Cohort of Postmenopausal Women.” J Am Geriatr Soc. 2018 Dec;66(12):2314-2320.
  5. Liu-Ambrose T, et al. “Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall: A Randomized Clinical Trial.” JAMA. 2019 Jun 4;321(21):2092-2100.
  6. Roitto HM, et al. “Relationship of Neuropsychiatric Symptoms with Falls in Alzheimer’s Disease – Does Exercise Modify the Risk?” J Am Geriatr Soc. 2018 Dec;66(12):2377-2381.
  7. Lee MS, et al. “Systematic reviews of t’ai chi: an overview.” Br J Sports Med. 2012 Aug;46(10):713-8.
  8. American Heart Association. “Tai Chi exercise may reduce falls in adult stroke survivors.” Science Daily, 02/06/2013. (
  9. Oregon Research Institute. “Tai Chi Program Helps Prevent Falls Among Older Adults.” Science Daily, 08/13/2008. (
  10. Pasiakos SM, et al. “Effects of high-protein diets on fat-free mass and muscle protein synthesis following weight loss: a randomized controlled trial.” FASEB J. 2013 Sep;27(9):3837-47.
  11. Rondanelli M, et al. “Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly.” Am J Clin Nutr. 2016 Mar;103(3):830-40.
  12. Houston DK, et al. “Delivery of a Vitamin D Intervention in Homebound Older Adults Using a Meals-on-Wheels Program: A Pilot Study.” J Am Geriatr Soc. 2015 Sep;63(9):1861-7.