Disclosures
2
Dr. Paddon-Jones is a Research Investigator with funding from the National Institute of Health and Dairy Research Institute. He is a member of the Scientific Advisory Board or Speaker’s Bureau for the National Dairy Council, US Dairy Export Council, American Egg Board, Texas Beef Council and Abbott Nutrition.
Dr. Mohr serves as a consultant to Daisy Cottage Cheese Health Network and the National Dairy Council.
Learning Objectives Suggested CDR Learning Codes: 2070, 4030, 4060; Level 2
1. Evaluate the latest data on the role of protein in building and/or maintaining lean body mass in a young and otherwise healthy population.
2. Discuss the role of leucine in protein synthesis.
3. Review the benefits and qualities of a variety of different types of protein, including plant proteins, dairy, meat and supplements.
4. Effectively counsel clients and patients by providing practical strategies for incorporating protein into goal-oriented meal plans.
3
The science of muscle metabolism
How much protein do we need – and when
Protein distribution and daily recommendations
Priority areas: aging, inactivity and illness
1
2
3
4
Presentation Overview
4
Ex
erc
ise
An
ab
olic
thera
pie
s
Inflammation
Disease
Inactivity
Mitochondrial
Dysfunction
Inadequate
Nutrition
Aging
Blood Flow
Conceptual Model…
6
How Much Protein Do We Need?? - a message of moderation -
* *
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
Fasting 30 g protein
Pro
tein
Syn
the
sis
(%/h
)
* *
Fasting 90 g protein
Young
Old
90 g protein 30 g protein
Symons et al, Am J Clin Nutr., 2007; Symons et al, J Am Diet Assoc., 2009f
1.2 g protein/kg/day
75kg adult
9
* *
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
Fasting Protein meal
Pro
tein
Syn
thes
is (
%/h
)
0.16
0.18
Young Elderly
* *
Protein + Exercise
50% increase
100% increase
Synergistic Effect of Protein and Exercise
Symons et al, J Nutr Health Aging, 2011
11
Net
Mu
scle
Pro
tein
Syn
the
sis
(mg
Ph
e/l
eg)
More than ~25 g
Reality: Age-related dose-response
0
10
20
30
40
50
60
Young
Elderly
Less than ~15 g
5 g
8 g
6 g
6 g
Katsanos et al, Am J Clin Nutr., 2005
12
Males 5th % 50th % 95th %
19-30 77 115 186
31-49 79 107 155
50-69 63 96 144
70+
Females
19-30 47 74 120
31-49 50 73 107
50-69 47 70 101
70+ 38 61 95
Protein consumed in Australia (grams per day)
I’m glad I moved!
15
McLennan and Podger, ABS and CDHAC, 1998
0
5
10
15
20
25
30
35
40
45
Breakfast Lunch Dinner Snacks
Pro
tein
co
nsu
me
d p
er
me
al (
g) Total: ~ 88 g/day
National Health and Nutrition Examination Survey (NHANES) 2003-2004
16
Total Protein
90 g
Ca
tab
oli
sm
A
na
bo
lis
m
10 g
maximum rate of protein synthesis
15 g 65 g
~ 1.3 g/kg/day
A skewed daily protein distribution fails to maximize potential for muscle growth.
Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care., 2009
17
Ca
tab
oli
sm
A
na
bo
lis
m
10 g
maximum rate of protein synthesis
15 g 65 g
Humans have a limited ability to store excess protein for later. anabolic use
Total Protein
90 g
~ 0.7 g/kg/day ?
Usable Protein
55 g ?
30 g
X
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Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care., 2009
Ca
tab
oli
sm
A
na
bo
lis
m
maximum rate of protein synthesis
30 g 30 g 30 g
Total Protein
90 g
greater 24 h protein synthesis response ?
~ 1.3 g/kg/day
Usable Protein
90 g
Optimizing Protein Consumption
19
Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care., 2009
Cat
abol
ism
A
nabol
ism
30 g 30g 30 g
Exercise:
Exercise/ Rehab and Protein Distribution
20
Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care., 2009
* *
10 - 15 - 65 g 30 - 30 - 30 g
25%
Older (?)
23
Protein Distribution Impacts Muscle Protein Synthesis
Mamerow et al, J Nutr., 2014
Hunger/Satiety ~30g protein/meal may be enough
24
30 g vs. 65 g protein
*
30 g vs. 10 g protein
↑ Hungry
↓ Full
Mamerow et al, J Nutr., 2014
If You are Hospitalized- You are Put in Bed
Inactive
(0 steps/min)
Low Activity
(< 15 steps/min)
0
10
20
30
40
50
60
70
80
90
100
%
Time
26
-1500
-1000
-750
-500
-250
0
250
Lo
ss
of
lea
n l
eg
ma
ss
(g
)
-2000
Healthy Young
28 Days Inactivity
2%
total lean leg mass
Healthy Elders
10 Days Inactivity
10% total lean leg mass
Paddon-Jones et al, J Clin Endocrinol Metab., 2004; Kortebein et al, JAMA, 2007
3 times more
muscle loss
1/3 the time
All volunteers
consumed the
RDA for protein
Inactivity and Aging Muscle
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Is 50 the new 70?
Age (y) Bed rest LLM change (g)
Rate (g/d)
Young 38 ± 8 28 days - 400 -14
Middle aged
52 ± 4 14 days - 1164 -83
Older 67 ± 5 10 days - 950 -95
28
Paddon-Jones et al, J Clin Endocrinol Metab., 2004; English et at, PhD Thesis, 2013 Elderly data from Kortebein, JAMA, 2007
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
0.1
Day 1 Day 10
Pro
tein
Synth
esis
(%
/h)
* 30%
Kortebein et al, JAMA, 2007
+ amino acids
Inactivity Anabolic Resistance: rescued by protein?
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Leucine has a key regulatory role on
muscle protein synthesis
…you probably
don’t need extra though
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Breakfast Lunch Dinner
Immediate challenge: correct the absurd
32
For all healthy adults…
Establish a dietary framework that includes a moderate amount of high quality protein at each meal.
Modify as necessary to accommodate individual needs:
• energy requirements
• physical activity
• health status
• body composition goals
• dentition, satiety
Recommendations: Prevention & Treatment
33
React aggressively to develop a
nutritional framework to reduce
the rapid loss of muscle and
strength associated with short-
term physical inactivity, illness
or injury
Recommendations: Prevention and
Treatment
34
Uncomplicated Sarcopenia vs. Catabolic Crisis Model
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17
19
21
23
25
27
29
31
40 44 48 52 56 60 64 68 72 76 80 84 88
Age (yrs)
Mu
scle
ma
ss (
kg
)
English and Paddon-Jones, Curr Opin Clin Nutr Metab Care., 2010
35
Nutrition and Metabolism
Medical Team • Elena Volpi
• Rene Przkora
• Randall Urban
• James Pattarini
• Charles Mathers
Paddon-Jones Lab • Emily Arentson-Lantz
• Jennifer Ellison
• Kirk English
• Sneha Nagamma
• Jean Gutierrez
Colleagues • ITS-CRC Nursing & Bionutrition Staff
• Melinda Sheffield-Moore and lab
• Blake Rasmussen and lab
• Elena Volpi and lab
• Don Layman
• Research volunteers
Funding • RO1 NR012973
• NSBRI (NNJ08ZSA002N)
• Texas Space Grant Consortium
• UTMB Claude D. Pepper Older Americans Independence Center (NIH)
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There’s no way I can eat that much
Beans & legumes
give you as much
protein as meat
Eating
breakfast is
not beneficial
More is
always
better
High protein diets cause kidney
problems
High protein diets are
bad for your bones
Plant proteins
are as good
I get enough
protein in my diet
Protein Myths
38
You need a TON of
protein to see benefits
Everyone needs the
same amount of protein Beans & legumes
give you as much
protein as meat Meal-replacement
protein bars &
shakes are
identical
There’s no way I can eat that much
Eating
breakfast is
not beneficial
More is
always
better
High protein diets cause kidney
problems
High protein diets are
bad for your bones
Plant proteins
are as good
Only people who
want to bulk up or
build muscle need
higher protein
diets
High protein
diets make you
crave sweets
Protein Myths
39
You need a TON of
protein to see benefits
Food (Portion) Leucine (grams)
Low Fat Cottage Cheese (1 cup) 2.6
Chicken Breast (3 oz) 2.6
Whey protein isolate (20 grams) 2.4
Ground beef (3 oz) 2.0
Wild Salmon (3 oz) 1.6
Black beans (1 cup) 1.2
Skim milk (1 cup) 0.8
Whole egg (1 medium) 0.8
Peanut butter (2 TBS) 0.5
Almonds (1 oz) 0.4
43
Balancing Intake
150 Pound Woman Eating 1500 Calories
Breakfast • Coffee with milk
Snack • Orange • Handful of almonds
Lunch • 2 slices whole grain bread • Peanut butter & jelly • 1 apple
Dinner • 4 oz chicken • 1 baked potato • 2 tablespoons sour cream • Steamed broccoli
Evening Snack • Bowl of ice cream
44
50 g total protein
13% protein
Optimal Intake
150 Pound Woman Eating 1500 Calories
Breakfast • Egg, spinach, and beef burrito
Snack • 1/2 cup cottage cheese • Orange • Handful of almonds
Lunch • 1 whole grain tortilla • 4 oz turkey • 1 slice cheese • Guacamole • 1 apple
Dinner • 4 oz flank steak • 1 baked potato • 2 tablespoons Greek yogurt • Steamed broccoli
45
100 g total protein
26% protein
Where Do We Get 25-30 Grams of Protein?
1 cup cottage cheese
1 cup Greek yogurt
1 scoop protein powder
1 can/packet tuna or salmon
2 whole eggs + 4 egg whites
46
2 oz Parmagiano cheese
3 oz beef jerky (about the size of your iphone)
4 oz beef
4 oz poultry
4 oz seafood
Everyone needs the
same amount of protein Beans & legumes
give you as much
protein as meat Meal-replacement
protein bars &
shakes are
identical
There’s no way I can eat that much
Eating
breakfast is
not beneficial
More is
always
better
High protein diets cause kidney
problems
High protein diets are
bad for your bones
Plant proteins
are as good
High protein diets
cause kidney
problems.
High protein
diets make you
crave sweets
Protein Myths
47
You need a TON of
protein to see benefits
Optimal Protein Range
51
40
30
20
10
0
2-3 4-8 9-13 14-19 19-30 31-50 51-70 71+
OPTIMAL: 25% - 30%
AMDR UPPER RANGE: 35%
AMDR LOWER RANGE 10%
Age in Years
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3. Select the Evaluation icon to complete and submit the evaluation.
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