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 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.

3 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.

4 Presentation Overview 1 The science of muscle metabolism 2 How much protein do we need – and when 3 Protein distribution and daily recommendations 4 Priority areas: aging, inactivity and illness

5 The Science of Muscle Metabolism 1

6 Conceptual Model… Inactivity Disease Inflammation Exercise Mitochondrial Dysfunction therapies Anabolic Inadequate Nutrition Aging Blood Flow

7 Stable Isotope Methodology ( ring - 13 C 6 - Phenylalanine) Artery Synthesis Breakdown Vein

8 How Much Protein – And When? 2

9 How Much Protein Do We Need?? 1.2 g protein/kg/day  75kg adult - a message of moderation - 90 g protein 30 g protein 0.14 Protein Synthesis (%/h) * * * * 0.12 0.1 0.08 0.06 0.04 Young Old 0.02 0 Fasting 90 g protein Fasting 30 g protein Symons et al, Am J Clin Nutr. , 2007; Symons et al, J Am Diet Assoc ., 2009 f

10 Biggest Health Risk of Too Much Protein…

11 Synergistic Effect of Protein and Exercise * * 0.18 0.16 0.14 Protein Synthesis (%/ h) * * 100% increase 0.12 0.1 50% increase Young 0.08 Elderly 0.06 0.04 0.02 0 Fasting Protein meal Protein + Exercise Symons et al, J Nutr Health Aging , 2011

12 Reality: Age-related dose-response 60 Net Muscle Protein Synthesis 6 g 50 Young ung Elderly derly (mg Phe/leg) 40 5 g 30 20 8 g 10 0 Less than ~15 g More than ~25 g 6 g Katsanos et al, Am J Clin Nutr. , 2005

13 Protein Distribution & Recommendations 3

14 …But Don’t We Already Eat Enough Protein? = ? +

15 Protein consumed in Australia (grams per day) 5 th % 50 th % 95 th % Males 77 115 186 19-30 31-49 79 107 155 63 96 144 50-69 70+ I’m glad I moved! Females 19-30 47 74 120 31-49 50 73 107 50-69 47 70 101 70+ 38 61 95 McLennan and Podger, ABS and CDHAC, 1998

16 National Health and Nutrition Examination Survey (NHANES) 2003-2004 45 Total: ~ 88 g/day Protein consumed per meal (g) 40 35 30 25 20 15 10 5 0 Breakfast Lunch Dinner Snacks

17 A skewed daily protein distribution fails to maximize potential for muscle growth. maximum rate of protein synthesis Catabolism Anabolism Total Protein 90 g 65 g 15 g 10 g ~ 1.3 g/kg/day Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care. , 2009

18 Humans have a limited ability to store excess protein for later. anabolic use maximum rate of protein synthesis Catabolism Anabolism Total Protein 90 g X 65 g 15 g 10 g 30 30 g g in Usable le Prote tein 55 g ? 55 ~ 0.7 g/kg/day ? Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care. , 2009

19 Optimizing Protein Consumption maximum rate of protein synthesis Catabolism Anabolism Total Protein 90 g 30 g 30 30 30 g 30 30 g in Usable le Prote tein 90 90 g ~ 1.3 g/kg/day Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care. , 2009  greater 24 h protein synthesis response ?

20 Exercise/ Rehab and Protein Distribution Exercise: Catabolism Anabolism 30 30 g 30 30 g 30 30 g Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care. , 2009

21 30-gram Protein Breakfast ideas

22 Protein Distribution Impacts Muscle Protein Synthesis *** Older (?) Mamerow et al, J Nutr ., 2014

23 Protein Distribution Impacts Muscle Protein Synthesis * * 25% 30 - 30 - 30 g 10 - 15 - 65 g Older (?) Mamerow et al, J Nutr ., 2014

24 Hunger/Satiety ~30g protein/meal may be enough 30 g vs. 10 g protein * ↑ Hungry 30 g vs. 65 g protein ↓ Full Mamerow et al, J Nutr ., 2014

25 4 Priority Areas: Aging, Inactivity, Illness

26 If You are Hospitalized- You are Put in Bed 100 90 80 % 70 Time 60 50 40 30 20 10 0 Inactive Low Activity (0 steps/min) (< 15 steps/min)

27 Inactivity and Aging Muscle 250 Healthy Young Healthy Elders 28 Days Inactivity 10 Days Inactivity Loss of lean leg mass (g) 0 3 times more -250 muscle loss 1/3 the time -500 2% total lean leg mass -750 All volunteers consumed the -1000 RDA for protein 10% -1500 total lean leg mass -2000 Paddon-Jones et al, J Clin Endocrinol Metab ., 2004; Kortebein et al, JAMA , 2007

28 Is 50 the new 70? Age (y) Bed rest LLM Rate (g/d) change (g) 38 ± 8 Young 28 days - 400 -14 Middle 52 ± 4 14 days - 1164 -83 aged 67 ± 5 Older 10 days - 950 -95 Paddon-Jones et al, J Clin Endocrinol Metab ., 2004; English et at, PhD Thesis, 2013 Elderly data from Kortebein, JAMA , 2007

29 Inactivity  Anabolic Resistance: rescued by protein? 0.1 0.09 Protein Synthesis (%/h) 0.08 0.07 30% * 0.06 0.05 0.04 0.03 0.02 0.01 0 Day y 1 Day y 10 + a amino ino acids ids Kortebein et al, JAMA , 2007

30 Leucine has a key regulatory role on muscle protein synthesis …you probably don’t need extra though

31 Conclusions and Recommendations

32 Immediate challenge: correct the absurd Breakfast Lunch Dinner

33 Recommendations: Prevention & Treatment 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

34 Recommendations: Prevention and Treatment tment 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

35 Uncomplicated Sarcopenia vs. Catabolic Crisis Model 31 29 27 Muscle mass (kg) 25 23 21 19 17 15 40 44 48 52 56 60 64 68 72 76 80 84 88 Age (yrs) English and Paddon-Jones, Curr Opin Clin Nutr Metab Care. , 2010

36 Paddon-Jones Lab Medical Team • Emily Arentson-Lantz • Elena Volpi • Jennifer Ellison • Rene Przkora • Kirk English • Randall Urban • Sneha Nagamma • James Pattarini • Jean Gutierrez • Charles Mathers 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) Nutrition and Metabolism

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38 Protein Myths There’s no way I can eat that much I get enough High protein diets cause kidney problems protein in my diet Beans & legumes More is give you as much always protein as meat better Eating High protein diets are breakfast is bad for your bones not beneficial You need a TON of Plant proteins protein to see benefits are as good

39 Protein Myths There’s no way I can eat that much Only people who High protein diets cause kidney want to bulk up or problems Everyone needs the same amount of protein Beans & legumes build muscle need More is give you as much Meal-replacement higher protein always protein as meat protein bars & better diets Eating shakes are High protein diets are identical breakfast is bad for your bones not beneficial High protein You need a TON of diets make you Plant proteins protein to see benefits are as good crave sweets

40 10 - 35%

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43 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

44 Balancing Intake 150 Pound Woman Eating 1500 Calories • Coffee with milk Breakfast • Orange Snack • Handful of almonds • 2 slices whole grain bread Lunch 50 g total protein • Peanut butter & jelly 13% protein • 1 apple • 4 oz chicken Dinner • 1 baked potato • 2 tablespoons sour cream • Steamed broccoli • Bowl of ice cream Evening Snack

45 Optimal Intake 150 Pound Woman Eating 1500 Calories • Egg, spinach, and beef burrito Breakfast • 1/2 cup cottage cheese Snack • Orange • Handful of almonds 100 g total protein • Lunch 1 whole grain tortilla 26% protein • 4 oz turkey • 1 slice cheese • Guacamole • 1 apple • 4 oz flank steak Dinner • 1 baked potato • 2 tablespoons Greek yogurt • Steamed broccoli