Disclosures Dr. Paddon-Jones is a Research Investigator with - - PowerPoint PPT Presentation
2 Disclosures 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 Speakers Bureau for the National Dairy Council, US
Disclosures
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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.
Health Network and the National Dairy Council.
Learning Objectives
Suggested CDR Learning Codes: 2070, 4030, 4060; Level 2
and/or maintaining lean body mass in a young and otherwise healthy population.
types of protein, including plant proteins, dairy, meat and supplements.
strategies for incorporating protein into goal-oriented meal plans.
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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
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The Science of Muscle Metabolism
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1
Exercise
Anabolic therapies
Inflammation Disease Inactivity Mitochondrial Dysfunction Inadequate Nutrition Aging Blood Flow
Conceptual Model…
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Artery Vein
Stable Isotope Methodology
(ring - 13C6 - Phenylalanine)
Synthesis Breakdown
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How Much Protein – And When?
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How Much Protein Do We Need??
* *
0.02 0.04 0.06 0.08 0.1 0.12 0.14
Fasting 30 g protein
Protein Synthesis (%/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
Biggest Health Risk of Too Much Protein…
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* *
0.02 0.04 0.06 0.08 0.1 0.12 0.14
Fasting Protein meal
Protein Synthesis (%/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 Muscle Protein Synthesis (mg Phe/leg) More than ~25 g
Reality: Age-related dose-response
10 20 30 40 50 60
Young ung Elderly derly
Less than ~15 g
5 g 8 g 6 g 6 g
Katsanos et al, Am J Clin Nutr., 2005 12
Protein Distribution & Recommendations
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…But Don’t We Already Eat Enough Protein?
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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
5 10 15 20 25 30 35 40 45
Breakfast Lunch Dinner Snacks
Protein consumed per meal (g) Total: ~ 88 g/day
National Health and Nutrition Examination Survey
(NHANES) 2003-2004
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Total Protein
90 g
Catabolism Anabolism 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
Catabolism Anabolism 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 le Prote tein in
55 55 g ?
30 30 g
g
X
18 Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care., 2009
Catabolism Anabolism
maximum rate of protein synthesis
30 30 g 30 30 g 30 30 g
Total Protein
90 g
greater 24 h protein synthesis response ?
~ 1.3 g/kg/day Usable le Prote tein in
90 90 g
Optimizing Protein Consumption
19 Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care., 2009
Catabolism Anabolism 30 30 g 30 30g 30 30 g Exercise:
Exercise/ Rehab and Protein Distribution
20 Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care., 2009
30-gram Protein Breakfast ideas
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Protein Distribution Impacts Muscle Protein Synthesis
22 Mamerow et al, J Nutr., 2014
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Older (?)
*
*
10 - 15 - 65 g 30 - 30 - 30 g
25%
Older (?)
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Protein Distribution Impacts Muscle Protein Synthesis
Mamerow et al, J Nutr., 2014
Hunger/Satiety
~30g protein/meal may be enough
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30 g vs. 65 g protein
*
30 g vs. 10 g protein
↑ Hungry ↓ Full Mamerow et al, J Nutr., 2014
Priority Areas: Aging, Inactivity, Illness
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4
If You are Hospitalized- You are Put in Bed
Inactive (0 steps/min) Low Activity (< 15 steps/min) 10 20 30 40 50 60 70 80 90 100
% Time 26
250
Loss of lean leg mass (g)
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
Middle aged 52 ± 4 14 days
Older 67 ± 5 10 days
28 Paddon-Jones et al, J Clin Endocrinol Metab., 2004; English et at, PhD Thesis, 2013
Elderly data from Kortebein, JAMA, 2007
0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 0.09 0.1
Day y 1 Day y 10
Protein Synthesis (%/h)
*
30% Kortebein et al, JAMA, 2007
+ a amino ino acids ids
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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Conclusions and Recommendations
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Breakfast Lunch Dinner
Immediate challenge: correct the absurd
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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:
Recommendations: Prevention & Treatment
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React aggressively to develop a nutritional framework to reduce the rapid loss of muscle and strength associated with short- term physical inactivity, illness
Recommendations: Prevention and
Treatment tment
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Uncomplicated Sarcopenia vs. Catabolic Crisis Model
15 17 19 21 23 25 27 29 31 40 44 48 52 56 60 64 68 72 76 80 84 88 Age (yrs)
Muscle mass (kg)
English and Paddon-Jones, Curr Opin Clin Nutr Metab Care., 2010 35
Nutrition and Metabolism
Medical Team
Paddon-Jones Lab
Colleagues
Funding
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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
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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
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You need a TON of protein to see benefits
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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
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Balancing Intake
150 Pound Woman Eating 1500 Calories
Breakfast
Snack
Lunch
Dinner
Evening Snack
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50 g total protein 13% protein
Optimal Intake
150 Pound Woman Eating 1500 Calories
Breakfast
Snack
Lunch
Dinner
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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
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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
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You need a TON of protein to see benefits
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Choose Lose
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Optimal Protein Range
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40 30 20 10 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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