Download Understanding Optimal Levels Of Protein And Carb To Prevent

4/16/2015
Understanding Optimal Levels of
Protein and Carbohydrate
To Prevent Obesity, Sarcopenia, and Metabolic
Syndrome
By Mary Donkersloot, RD
Nutritionist, Private Practice
Beverly Hills, CA
Disclosures
• Consultant to:
Egg Nutrition Center
ALDI Supermarkets
New Evidence Suggests an Alternative
Hypothesis:
• Refined carbohydrates
stimulate insulin, which
promotes inflammation,
obesity, and CVD.
• Replacing refined
carbohydrates with protein
promotes a more favorable
metabolic response.
• Cholesterol less the issue
• Focus on healthy fats
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Increasing Protein Intake
• Could:
– Assist obese with weight loss
– Help decrease incidence type 2 diabetes,
metabolic syndrome
– Play a role in attenuating bone loss and muscle
loss with age
Increase quality of life & decrease health care
costs
RDA
Risk of
Inadequacy
Risk of Adverse
Affects
acceptable
intake
Protein: 0.8 g/kg 2.5 g/kg
Who has higher protein need?
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The Protein Myth
Assumption in dietary guidance:
Adults eat more protein than they need
Truth: adults eat more protein than the
minimum needed to prevent deficiency.
Truth: meeting minimum protein needs
does not meet optimal health needs.
Wolfe RR, Miller SL, The recommended dietary allowance of protein:
a misunderstood concept. JAMA. 2008 Jun 25;299(24):2891-3
How Much Protein?
• Goal: 60-90 grams per day
• Goal: 15-30 grams per meal
• It takes 20 grams of protein to fully
stimulate muscles
• Less than 15 grams of protein contains too
little leucine
9 Essential Amino Acids
Histidine
Phenylalanine
Threonine
Lysine
Methionine
Tryptophan
Leucine, Isoleucine, Valine:
• Research is suggesting that leucine is the
one of most important amino acids for
muscle building BECAUSE it is the dietary
signal to trigger protein synthesis."
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Signaling Pathway –Muscle Synthesis
insulin
“anabolic drive”
leucine
mTOR
protein synthesis
Leucine “Requirements” vs “Needs”
Requirements
• Essential amino acid for
substrate needs
– RDA for leucine =
<3g/day
Needs
• Leucine signal requires
.5 to 3.0 g of dietary
leucine per meal
Or about 8 g/day
~30g of protein/meal
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Getting Breakfast Right
Egg & meat breakfast
Prot
Carbs
Fat
kcals
2 eggs
14
0
10
140
Veggie Burger
11
10
15
125
1/3 avocado
0
6
10
100
Berries 3/4 cup
0
10
0
40
Kefir 1% (1/2 cup)
7
10
1
80
total =
32
34
26
485
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Getting Breakfast Right
Protein Shake
Prot
Carbs
Fat
kcals
Greek yogurt (1 cup)
20
4
0
100
whey powder
16
3
2
100
berries (3/4 cup)
0
10
0
40
total =
36
27
3
280
Low-Carb, High Protein Diets
• In short-term studies (6 months), low-carb
diets are more effective in weight loss than
low-fat diets
• Low- carb diets increase HDL, and
decrease TG, but may increase LDL
• Long-term effects of low-carb diets on
health outcomes depends on types of fat
and protein.
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Ad Libitum High Protein Diet Led to Greater
Weight Loss
N = 65
Controls
Hi CHO (58/12/30, CHO/PRO/FAT)
HI PRO (45/25/30, CHO/PRO/FAT)
Skov et al., Int J Obesity 1999;23:528-536
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Nutrients in Plant Protein Foods
Beans
Black beans (86 g)
Chickpeas (82 g)
Great northern beans (88.5 g)
Kidney beans (88.5 g)
Lentils (99 g)
Pinto beans (85.5 g)
Nuts (1 ounce serving)
Almonds
Peanuts Pistachios
Walnut Soy
Soybeans (1/2 cup cooked) Tofu (1/2 cup)
Protein
g
Iron
mg
Zinc
mg
Calcium Potassium Magnesium Folate
mg
mg
mg
μg
7.6
7.5
7.4
7.7
8.9
7.7
1.8
2.4
1.9
2.0
3.3
1.8
0.96
1.2
0.78
0.9
1.3
0.8
23
40
60
31
19
40
305
239
346
358
365
373
60
39
44
37
35
43
128
141
90
115
179
147
6.0
8.0
5.8
4.3
1.1
0.4
1.1
0.8
0.9
0.9
0.6
0.9
75
17
30
28
200
206
291
125
76
50
34
45
14
34
14
28
14.3
10
4.4
1.4
1.0
1.0
88
130
443
186
74
127
47
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Usual U.S. Intake of Protein and Food
Sources
> 2 years of age
Food Group Serving
Protein (g)
Plant Based Protein:
1.6 cups
3.2
Grains
Vegetables 6.4 oz
12.8
Nuts/seeds/soy
0.5 oz
3 TOTAL:
19
Animal Protein:
Milk/dairy
1.5 cups
12
Meat
2.5 oz
17.5
Poultry
1.2 oz
8.4
Eggs
0.4 oz
2.8
Fish/seafood
0.5 oz
TOTAL:
U.S. average protein intake 63.2 g daily:  30% plant  70% animal 3.5
44.2
http://www.cnpp.usda.gov/dietary‐guidelines‐2010
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Carbohydrates
• Are really only needed for a fuel source.
• The need for carbohydrates is directly
related to the amount of fuel you burn in
muscles.
• This is your carbohydrate tolerance.
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Carbohydrate RDA
Food and Nutrition Board set an RDA for
carbohydrates at a daily intake of 130 grams
in 2002.
Food Plan – 130 Grams Carb
• 5 servings of vegetables
• 2 servings of fruit
• 3 small servings of lentils, beans, high
fiber bread, brown rice or high fiber cereal
Protein:Carb 1:1
• Young competitive athlete 1:4
• Sedentary adult 1:1
• Weight loss 1:1 or 1:2
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My Plate: Low-Glycemic
Eating
Vegetables
Protein
Legumes & Whole Grains
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Conclusions
• Decreasing carbs and increasing lean protein or
unsat fat has beneficial effects on weight control,
CVD, and diabetes risk factors.
• Some individuals will benefit from higher protein
intakes distributed throughout the day.
• “Protein package” is important: plant based
protein sources have other beneficial nutrients and
bioactive compounds.
• Choose a variety of protein food which include
seafood– lean meat, poultry, eggs, beans and
peas, soy products, and unsalted nuts and seeds.
Mary Donkersloot, RD
Nutritionist
Private Practice
462 North Linden Drive, Ste. 445
310-275-9241
[email protected]
What We Eat In America, NHANES 20112012 Males and Females, > 20 years of Age
Calories
Energy
2191 Protein
16%
Carbohydrate
Fat
Protein ≈ 88 g/day
49%
33%
SFA
11%
MUFA
12%
PUFA
8%
Alcohol
3%
http://www.ars.usda.gov/SP2UserFiles/Place/80400530/pdf/1112/Table_5_EIN_GEN_11.pdf
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Those who
consumed ≈17% to
21% (Q4) vs 8% of
calories from added
sugar had a 38%
higher risk of CVD
mortality.
Lines show adjusted HRs from Cox models. Midvalue of quintile 1 (7.4%) was the reference
standard. The model was adjusted for age, sex, race/ethnicity, educational attainment, smoking
status, alcohol consumption, physical activity level, family history of CVD, antihypertensive
medication use, Healthy Eating Index score, BMI, systolic blood pressure, total serum cholesterol,
and total calories. Solid line indicates point estimates; dashed lines indicate 95% CIs.
Yang et al. JAMA Intern Med. Published online February 3, 2014.
Strategies for Increasing Dietary
Protein/Plant Protein
Substitute plant protein for animal protein foods Replace CHO (especially refined) with protein/plant protein foods
Replace fat (preferably SFA) with protein/plant protein foods
Summary
• By decreasing CHO and increasing lean
protein OR unsaturated fat – CVD risk factors
are improved
• A diet higher in CHO can be improved by
replacing some of the CHO calories with
protein or unsaturated fat
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OmniHeart Trial Design
161 patients age >30 years; systolic blood pressure 120‐159 mmHg or diastolic blood pressure 80‐99 mmHg
45% female, mean age 53.6 years, 930 patients screened
Randomized. Crossover. Controlled Feeding – 6 Weeks.
Standard DASH Diet
carbohydrates (58%) protein (15%) fat (27%)
Protein Modified DASH Diet
carbohydrates (48%) *protein (25%)
fat (27%)
Unsaturated Fat Modified DASH Diet
carbohydrates (48%) protein (15%)
fat (37%) MUFA (21%), PUFA (10%) SFA (6%)
*125 g protein on 2000kcal
Appel et al. JAMA 2005;294:2455‐2464.
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