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Protein & Health: What Should We Be Telling Our Patients Based on Research and Dietary Guidelines?

When the Box Says 'Protein,' Shoppers Say 'I'll Take It’ Sarah Nassauer, March 2013

Christopher Gardner, PhD Professor of Medicine Stanford Prevention Research Center

Dieter, Fitness Buff, Office Worker, Mom

Food and Agricultural Organization

2009

Per capita meat consumption (kg/year)

Per capita GDP and meat consumption by country, 2005

~126 kg/year ~280 lbs/year

Per capita GDP US $ PPP

8 grams sugar

42 grams Protein

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Outline Ø  IOM

Dietary Reference Intakes (DRI)

/ Nat’l Recommendations

Institute of Medicine 1357 pages

Ø  Minimum / Optimal / Maximum – CONFUSION? Ø  Protein Quality Ø  Impact of Shifting from Animal to Plant-Based Proteins

Dietary Reference Intakes (DRI)

EAR: Estimated Average Requirement RDA: Recommended Daily Allowance

Daily estimated intake of protein by Americans

111 g/day (adjust down for waste) The data are from 2006, based on data published in 2011, and accessed April 28, 2014. (http://www.ers.usda.gov/data-products/food-availability-%28per-capita%29-data-system/.aspx#.U168mlfiiSp) (https://fnic.nal.usda.gov/food-composition/usda-nutrient-data-laboratory)

= EAR + 2 standard deviations Population / public health approach Adequate for 97.5% of the population Daily estimated intake of protein by Americans: 80

g/day

(adjust up for under-reporting)

Req’t / Rec / Intake 125 lbs 175 lbs 225 lbs 275 lbs (57 kg) (80 kg) (102 kg) (125 kg) Estimated Average Requirement

0.66 g/kg

38 g

52 g

67 g

82 g

Recommended Daily Allowance

0.8 g/kg

46 g

64 g

82 g

100 g

1.2 - 1.5 g/kg (NHANES)

68-86 g

Average American Intake

96-120 122-153 150-187 g g g

Acceptable macronutrient distribution ranges (AMDR) Percentages of daily calories from carbohydrate, fat and protein sufficient to provide adequate total energy intake and nutrients while reducing the risk of chronic disease.

10-35% Protein 45-65% Carbohydrate 20-35% Fat IOM – Dietary Reference Intakes

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Acceptable macronutrient distribution ranges (AMDR) Percentages of daily calories from carbohydrate, fat and protein sufficient to provide adequate total energy intake and nutrients while reducing the risk of chronic disease.

10-35% Protein 10% of a typical caloric intake translates to 0.95 g/kg/d and 35% of energy intake translates to 3.3 g/kg/d.

Outline Ø  IOM / Nat’l Recommendations

Ø  Minimum / Optimal / Maximum CONFUSION? Ø  Protein Quality Ø  Impact of Shifting from Animal to Plant-Based Proteins

IOM – Dietary Reference Intakes

JAMA, June 25, 2008—Vol 299, No. 24 pp 2891-2893

Minimal? Answerable

The recommended dietary allowance (RDA) is an estimate of the minimum daily average dietary intake level that meets the nutrient requirements of nearly all (97 to 98 percent) healthy individuals.

Optimal?

…the minimum protein intake necessary to avoid a progressive loss of lean body mass as reflected by nitrogen balance.

Unanswerable

Minimal Nitrogen Balance Studies Maintaining Lean Muscle Mass

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Protein Use 1. Functional No Storage

Protein

2. Carbohydrate

Nitrogen

NH3 (Ammonia)

(for immediate need, or conversion to glycogen)

3. Fat (conversion for energy storage)

Minimal Nitrogen Balance Studies Maintaining Lean Muscle Mass Protein Storage?

Optimal For what? Building Muscle Mass

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Weight Gain Example (hypothetical) Ø  Goal: 22 pounds of muscle growth (lean tissue) in one year Ø  22 pounds = 10 kilos Ø  Lean tissue = 70% water (7 kg), 30% protein (3 kg) Ø  3 kg = 3,000 g Ø  3,000 g divided by 365 days in a year is LESS THAN 10 g/day Ø  10 g/day above your requirement for maintenance (NOT above your current intake)

Optimal For what? Building Muscle Mass Weight Loss - Satiety

(Need to factor in amino acids used for fuel while doing the resistance training required to gain the muscle)

Optimal For what? 18 normal-weight women consumed ad libitum lunch and dinner entrées 1 day a week that were covertly varied in protein content (10%, 15%, 20%, 25%, or 30% energy). CONCLUSION: No significant differences in hunger and fullness ratings across conditions or in taste and appearance ratings of the manipulated entrées. Varying the protein content of several entrées consumed ad libitum did not differentially influence daily energy intake or affect ratings of satiety.

Minimal? Answerable

Optimal?

Building Muscle Mass Weight Loss - Satiety Preventing Sarcopenia in Elderly Preventing Heart Disease and Cancer

Outline Ø  IOM / Nat’l Recommendations Ø  Minimum / Optimal / Maximum – CONFUSION?

Ø  Protein Quality Ø  Impact of Shifting from Animal to Plant-Based Proteins

Unanswerable

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10

Cys

His

Tyr

Trp

Met

Phe

Ile

Ser

Gly

Thr

Val

Pro

Ala

Arg

Leu

Lys

PLANT

Ground Beef Steak Pork Bacon Lamb Chicken breast Chicken leg Turkey breast Wild Salmon Farmed Salmon Tilapia Farmed Catfish Wild Catfish Sea Bass Shrimp Greek Yogurt

Pecans Walnuts Almonds Peanuts Dried peas Beans Tofu Tempeh Gardenburger Boca-Burger, Vegan Hummus Lentils WW Macaroni Butternut squash Sweet Potato Broccoli Kale Romaine Lettuce Raspberries

16 14 12 Low Methionine 10 8 6 4 2 0

His

Trp

Cys

Tyr

Met

Phe

Thr

Ile

Ser

Gly

Val

Pro

Ala

Lys

Leu

Glu/n

Arg

Trp

Cys

Met

His

Tyr

Phe

Thr

Ser

Gly

Ile

Val

Pro

Arg

Lys

Trp Thr Iso Leu Lys Met Cys Phe Tyr Val Arg His Ala Asp Glt Gly Pro Ser Asn Gln

Cys

Trp

Met

His

Tyr

Phe

Ser

Gly

Leu

Glu/n

High His Asp/n

Cys

Trp

Met

His

Tyr

Phe

Thr

Asp/n

Cys

His

Trp

Tyr

Phe

Met

Thr

Ile

Ser

Val

Ala

Lys

Gly Gly

Ile

Ser

Val

Ala

Arg

0

4

Grams

ANIMAL

Thr

Ile

Val

Pro

Ala

Lys

Leu

0

2

0

High Glu/n Glu/n

Cys

Trp

Met

His

Tyr

Phe

Thr

Gly

Ile

Ser

Val

Ala

Lys

Pro

2 Arg

4

2 Leu

4

Glu/n

6

4

2

For all 20 of the 20 amino acids

Broccoli Protein

8

6

Asp/n

Glu/n

10

Peanut Protein

8

Asp/n

Cys

His

Trp

Tyr

Met

Phe

Thr

Ile

Ser

Gly

Val

Ala

Lys

10

Pro

0

Arg

2

0

Leu

4

2 Glu/n

6

4

Asp/n

6

4

Amino Acid Distribution of 33 foods (per 40 grams of protein)

Black Bean Protein

8

Arg

Rice Protein

8

Non-Essen,al

Essen,al

Asp/n

10

6

Leu

Low Trp High Ala & Gly

Pork Protein

8

6

Lys

Ser Gly Thr Phe Tyr His Met Trp Cys

10

Beef Protein

Glu/n

Ile

Low Serine

Grams

Glu/nAsp/n Lys Leu Arg Pro Val Ala

Pro

Arg

Leu

0

Asp/n

2

Grams / 40 g protein

0

2

0

8

Amino Acids

Low Lys High Arg

4

2

10

0

Low Lysine

4

4

Chicken Protein

8 6

Glu/n

Low Proline

10

6

Asp/n

Essen,al Non-Essen,al

6

Non-Essen,al

Essen,al

Salmon Protein

8

Pro

Egg Protein

8

Grams / 40 grams

10

Ala

Grams / 40 g protein 10

2

Amino Acid Distribution of 33 foods (per 40 gram of protein)

For 2 of the 20 amino acids

Animal Animal

Plant

Plant

0

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Amino Acid Distribution of 33 foods (per 40 grams of protein)

Amino Acid Distribution of 33 foods (per 40 grams of protein)

For 7 of the 20 amino acids

For all 20 of the 20 amino acids

4

16 14 12 10 8 6 4 2 0

Grams

Grams

6

2 0

Trp

Thr

Iso

Leu

Lys

Met

Cys

Trp Thr Iso Leu Lys Met Cys Phe Tyr Val Arg His Ala Asp Glt Gly Pro Ser Asn Gln

Protein/100 Kcals Chicken Beef Salmon Pork Edamame Broccoli Egg Black beans Milk, whole Peanuts Quinoa Walnuts Rice Carrots Blueberries Banana

0

2

4

6

8

10

12

14

16

18

20

Grams

Food Proteins: Quality, Use, and Need …the source of protein (90 percent animal, 90 percent vegetable, or mixed) did not significantly affect the median nitrogen requirement, slope, or intercept. It should be noted that almost all of the studies included as 90 percent vegetable were based on complementary proteins.

“Concern about the quality of individual food proteins is of only theoretical interest in settings where food is abundant. Most people in the US and Canada eat a variety of nutritious foods to meet their energy needs – not just say, cookies, potato chips or alcoholic beverages. They would find it next to impossible not to meet their protein requirements, even if they were to eat no meat, fish, poultry, eggs, cheese or soy products.” Sizer and Whitney, Nutrition Concepts and Controversies

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Outline

Consider Four Diets

Ø  Standard Recommendations

Standard American Diet (SAD)

Ø  Minimum / Optimal / Maximum – CONFUSION?

Modified SAD – Shifting some animal to plant protein

Ø  Protein Quality

Enlightened – Less protein,

Ø  Impact of Shifting from Animal to Plant-Based Proteins

and shift some from animal to plant

Vegan diet – no animal products

Standard American Diet (SAD) Breakfast

Dinner

Lunch

105 g animal protein (85%)

Tyr

Ser

Gly

Pro

Cys

Glut/ine

Ala

Val

Trp

Arg

Non-Essential

Modified SAD Diet

Standard American Diet (SAD) Breakfast

23.2

Total intake 125 grams (excess)

Thr

Essential

20 g plant protein (15%)

Asp/ine

125 g protein (20%)

Phe

2,500 Kcal

Snack (1/2 cup)

Lys

(12 oz)

Met

cheeseburger (1/3 lb) 1 cup fries 12 oz soda

Snack

Iso

12 oz soda

Leu

club sandwich (bacon & turkey)

His

3 eggs 2 sl bacon Snack 1 sl toast (1 oz) 1 tb butter 8 oz milk

grams

Requirement of 40 grams total 16 14 12 10 8 6 4 2 0

Lunch

Dinner

85 grams broken down, converted to carbs or fats

Chef salad w/ ham & chz swtnd iced tea

Clif Bar latte

Essential

Non-Essential

Tyr

Ser

Gly

Pro

Cys

Glut/ine

Asp/ine

Ala

Arg

Val

Trp

Thr

Phe

Lys

Met

Iso

Leu

Snack His

grams

Requirement of 40 grams total 16 14 12 10 8 6 4 2 0

Snack

Beef / veggie stir fry white rice soda

Snack

2,500 Kcal 124 g protein (20%) 62 g animal protein (50%)

62 g plant protein (50%)

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Modified SAD (shift to more plant-based)

Breakfast

24.3

Total intake 124 grams (excess)

Enlightened Protein Shift Dinner

Lunch

84 grams broken down, converted to carbs or fats

45 g animal protein (50%)

Lunch

Dinner

Non-Essential

38 grams broken down, converted to carbs or fats

Non-Essential

Tyr

Ser

Gly

Pro

Glut/ine

Cys

Asp/ine

Ala

Arg

Val

Trp

Thr

Phe

Lys

Met

Leu

Very little, if any, cysteine or methionine broken down

Food and Agricultural Organization

2009

Per capita meat consumption (kg/year)

Per capita GDP and meat consumption by country, 2005

Total intake 78 grams (excess)

Iso

1/8 c cashews

6 sp asparagus

78 g plant protein (100%)

Requirement of 40 grams total

His

2 c Gypsy soup

Snack whole grain bread Snack

78 g protein (12%)

Vegan

Essential

Green salad beans, nuts veggies oil & vin

2,500 Kcal

Tyr

Ser

Gly

Pro

Glut/ine

Cys

Asp/ine

Ala

Arg

Val

Trp

Thr

Phe

Lys

Met

Leu

Iso

1 c oatmeal walnuts Snack mango latte (1/4 c) His

grams

45 g plant protein (50%)

50 grams broken down, converted to carbs or fats

Essential

grams

Snack

One of my vegan days Breakfast

Total intake 90 grams (in excess) Requirement of 40 grams total

16 14 12 10 8 6 4 2 0

Tofu / veggie stir fry brown rice sparkling H2O

Snack

90 g protein (14%)

Non-Essential

Enlightened Protein Shift 16 14 12 10 8 6 4 2 0

Salad w/ chicken & chz chips iced tea

2,500 Kcal

Tyr

Ser

Gly

Pro

Cys

Glut/ine

Asp/ine

Ala

Essential

Arg

Val

Trp

Thr

Phe

Lys

Met

Iso

Leu

Veggie omelette ww toast & butter Snack latte

His

grams

Requirement of 40 grams total 16 14 12 10 8 6 4 2 0

~126 kg/year ~280 lbs/year

Per capita GDP US $ PPP

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Environmental Working Group

EWG.org/meateatersguide

Water Footprint of Food

Vilsack: Dietary Guidelines Are About Health, Not Environment By Tennille Tracy, March 11, 2015

A panel of nutri,on experts generated controversy last month when it pressed the federal government to consider the environment when issuing new dietary guidelines later this year. Generally speaking, that would mean asking Americans to eat less meat and more plant-based foods. Agriculture Secretary Tom Vilsack suggested that, for him, the answer is no – that so-called sustainability issues fall outside the scope of the dietary guidelines. “I read the actual law,” Mr. Vilsack said. “And what I read …was that our job ul,mately is to formulate dietary and nutri,on guidelines.

Center for Science in the Public Interest

Executive Summary …regarding sustainable diets… a diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal-based foods is more health promo,ng and is associated with less environmental impact than is the current U.S. diet.

Physical AcLvity Guidelines included in 2000 DGA

2000 US Dietary Guidelines

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2015

In Summary

More than 29,000 people commented on the DGAC’s 2015 advisory report (compared to