Will that high protein diet kill you?

After last Tuesday’s television show ‘how not to get cancer’ I got a number of concerned emails and Facebook messages from people questioning their protein intake. Specifically,  information that a high protein diet increases health risk and mortality. As a nutritionist who advocates a higher protein load, here’s what I’ve read about the role of protein and disease, as written by people much smarter than I am:

Information regarding health risks associated with a high protein intake has been critically reviewed by experts in the field, specifically the way the population dietary data from the National Health and Nutrition Examination Studies (NHANES) was analysed to determine that higher levels of protein increase overall health risk. The major criticisms were:

  • They eliminated half of the data points with no explanation;
  • Their definition of low protein (below 10%) should in fact be labelled as ‘inadequate protein’ as defined by the Institute of Medicine (IOM) protein ranges (10-35% of dietary energy), and in New Zealand adequate protein is 15-25% of energy in diet. The arbitrary cut-off used by the authors meant less than 450 people fell into the ‘low protein’ group;
  • The population data gathered dietary information via a single 24-hour diet recall once in an 18-year period; and
  • Body weight or body mass index (BMI) was not reported – given the clear association between excess body fat and chronic disease such as cancer, cardiovascular disease etc, this was a massive oversight.

While the paper outlined in the review also looked at laboratory trials, these were based on rodent studies and not clinical trials in humans. Differences in metabolic rate, the way we utilise nutrients and digestive tracts (the rodents more able to handle fibrous foods than ours) means that, despite interesting findings, we cannot conflate the findings here to humans, as they are not directly transferable.

Other points to note regarding research suggesting that a lower protein diet is good for longevity:

  • Many of the studies are based on rodent studies (not humans) and, in addition to what I posted above, the type of protein studied is typically casein – a dairy protein that has more potential to be inflammatory and one rodents are not naturally adapted to consume;
  • High amounts of dairy protein have been found to increase insulin, triglycerides and result in excess body fat compared to other sources of protein provided to the rodents;
  • Much of the research also show that it could be an effect of a high methionine intake which – when not balanced with other amino acids such as gelatin) for some people, can build up the amount of homocysteine (another amino acid) that increases risk of cardiovascular disease;
  • As we age, we are at greater risk of sarcopenia, dyopenia and poor health due to falls if we don’t have a decent amount of muscle mass, which requires protein to help lay down this muscle;
  • The majority of studies point to a higher protein intake being protective for quality of life as we age, not detrimental; and
  • We become more anabolic resistant as we age, meaning we are unable to lay down muscle the way we are when we are younger to the same extent. This could be as a result of both inactivity and lower levels of oestrogen and testosterone, meaning the a higher protein intake is required (in addition to resistance training).

And here is what I know regarding a low protein diet in the real-world setting:

  1. People are hungry. Women, especially, struggle to eat an appropriate amount of food when they restrict protein. This restriction (intentional or otherwise) leads to poor blood sugar control, poor appetite control and mood problems (either low mood or increased anxiety).
  2. People can only restrict for so long until it backfires. A lower protein intake might be totally fine on a Monday, things are okay on a Tuesday, but by Wednesday people are climbing the walls looking for something to eat. Or, for some, this process happens across the course of a day. This means that despite having a decent amount of food at dinner, the undereating of protein across the day leaves you standing in the kitchen at 8pm looking for something to eat and wondering why you are not hungry, but just ‘not satisfied’.
  3. Practically speaking, when you restrict protein, what is there left to eat? Carbohydrate. We eat until our minimum requirement for protein is filled and, in the absence of quality protein sources we will overeat on calories (specifically carbohydrate calories) until this requirement is met. For many, this results in poor nutrient status, poor blood sugar control and excess body fat. It’s these three things which have consistently been found to result in increased risk of metabolic disease and cancer, not the protein load.
  4. People (generally speaking) fare best when we base their meals around protein and then toggle the fat and carbohydrate around that, based on their body composition and their activity levels. For many, this is more than a palm sized serve at each meal, and across the course of the day, for most people, this is at least 100g of protein from foods that are quality protein foods. In New Zealand, we get most of our protein (according to the most recent nutrition survey – which is 10 years old, actually) from bread. Bread! Wheat derived protein is one of the lower quality sources we can eat, with the amino acids not being as easy to digest and assimilate as those from animal-based sources.

So, clinically I am not at all concerned about advocating a moderate-high protein load for most people, and the television show last Tuesday did nothing to change my view on it. A longevity diet approach which is low in protein looks promising for a week a few times a year to confer benefits of fasting related to lifespan, but in terms of a day-to-day diet it will likely leave you frail, hungry and irritable. There is not enough human data to show that this approach will lead to a longer life, but I gotta say, it doesn’t sound like an enjoyable way to live beyond 100 years. Most evidence points to muscle mass being extremely important as we age to maintain quality of life and health span. This requires adequate protein and resistance training. In the words of Robb Wolf (as said on a recent podcast), we need to “eat and move in a way that lays down as much muscle as we can now, and then fight like the devil to keep it”.

how-much-protein-per-day-1296x728-feature

A good source of protein, and pretty delicious (PC: healthline.com)

AHSNZ Wanaka: a taste of what you missed

ICYMI, the second Ancestral Health Society of New Zealand symposium took place over Labour weekend, giving me a great excuse to head down to the South Island and reconnect with the geographical region I’ve spent much of my time over the years, and with the people who are part of my ‘tribe.’ I love love love the South Island and particularly Central Otago. It was so great to reconnect with fellow Ancestral Health New Zealand crew, meet up with old Dunedin friends and meet other like-minded people.

I am not going to give a detailed account of each presentation – in fact, I don’t need to as the presenters are each writing up a post that summarises their talks – two of which   I am sharing today so you can get a taste of what you missed. As a brief overview, there were a mixture of practitioners and advocates of evolutionary health – touching on topics from sustainable farming to endurance training to perceptions of body size ideals. While our first symposium had more of a focus on nutrition, this conference extended well beyond that.

The programme from the conference can be found here, and below are two posts already written up by Kate and Andrew. Read, ponder, and definitely keep an eye out for details of our next symposium looking to be held in the first quarter of next year.

Kate, the Holistic Nutritionist, an Australian import, did a detailed talk on the importance of the gut microbiome in determining our health

Dr Andrew Dickson (from Massey University), self-proclaimed Clydesdale and lover of trail running spoke about body mass and endurance athletes: perception via psycho-sociology

The day ended with a movement session that didn’t involve exercise; Max Bell (from MovNat New Zealand), Aaron Callaghan (Peak 40) and James Murphy (of Synergy Health) took us through movement and activity patterns that challenged the uncoordinated amongst us (i.e. me) but was suitable for all levels. This enabled pretty much all of the conference attendees to take part. Check out some of the pictures from this (and the conference in general) on the AHSNZ Facebook page here.

Overall – it was a brilliant day and a taste of things to come over the coming year. Along with the  one-day symposiums in the pipeline, we have our first international event planned for Queenstown next Labour weekend – with Melissa and Dallas Hartwig (Whole 9) and Dr Emily Deans already booked to present. I’m already counting down the days to this one – it’s 346 sleeps away.

AHS14 Pt 2: quick debrief

Wow, what a whirlwind 12 days. I arrived home this morning from LA at 5.45am with an additional suitcase and minus $85 for the 10kg it was carrying. I’m just thankful that I checked the luggage restrictions before heading to the airport or it could have been a lot worse. I am glad to be on home soil, not least because I think I averaged about 6h sleep a night for the time I was overseas. Now don’t go thinking it was because I was hitting any kind of night scene in a ‘bright lights, big city’ kind of way. Unless your version of that includes a cup of tea then you’re bang on. It was really that Caryn and I had so many things we wanted to see that sleep didn’t take priority. Thankfully, real life resumes and that will be rectified in the next week.

Of course, regular followers of my blog may be expecting a synopsis of the talks from the remaining two days of the conference, but I’ve been pipped at the post by the Ancestral Health Society which is brilliant – they’ve already uploaded a number of the talks and you can find them here. Which is great as the simultaneous streams meant that I was unable to see a number of talks I was interested in, so I’ll be able to catch up with them too. It also means I’ll be able to jot down a few take homes from the overall experience rather than focus on the talks. Both Caryn and I really enjoyed the conference as it was largely nutrition, largely paleo-based (unsurprisingly) and largely low carb too. Obviously there were a number of talks around the other tenets of ancestral health – but such a big part of it is around food (or how lifestyle interacts with nutrition) that we both agreed it was one of the most relevant conferences we’ve attended. Equally, we enjoyed that the conference was attended by people from such diverse backgrounds. While we all converged upon the University of Berkley because of our interest in evolutionary health – we mixed with personal trainers, researchers, academics, nurses, IT specialists, functional medicine practitioners…. Most conferences we’ve attended have largely been with others in our field, so it was a good opportunity to mingle with others on the basis of what they value more than what they have studied or teach in. As Caryn and I stayed in the dorms at Berkely we had an opportunity to mingle more than we would have with others, and enjoyed the company of Tim (who we met initially through Jamie and Anastasia), Darcie, Dana and Sarah either through bumping into them at breakfast or in the dorm rooms and all of whom we may see again next year in Boulder, Colorado for AHS15.

An obvious highlight of the trip was to meet in person those people I’ve either followed on Twitter, or that I’ve read their book or blog, or that I listen when I tune into their podcast. There were a number of ‘big hitters’ in the ancestral health space. It was such a pleasure to meet them and to not be disappointed. At the presenters dinner we sat down with Jamie and Anastasia and were joined with Michelle from Nom Nom Paleo, Steph from Stupid Easy Paleo and Dallas, half of the original Whole 9. I regularly direct people to these sites for recipe inspiration or information and it was great to recognise that they were people genuinely interested in helping others rather than only being motivated by making money. I also had a good chat to Dr Cate Shanahan – the LA Laker’s nutritionist and author of Deep Nutrition, and Caryn and I discussed Spartan events with Ben Greenfield and saturated fat and cholesterol over breakfast with Paul Jaminet, creator of the Perfect Health Diet. I also met Jimmy Moore, podcast host of Livin La Viva Low Carb, author of Cholesterol Clarity and Keto Clarity (which I’m reading right now – it is a brilliant guide for anyone interested in ketogenic diets). A further bonus was being invited to dine with Jeffry Geber (Denver’s Diet Doctor) and his family – along with Gary Taubes. We discussed bad science and what to do with it, and at the end of the conference we came away from dinner not feeling in awe of the company that we had kept but more inspired by the work that is going on to help spread the ancestral health message.

Importantly, though, the conference was a great chance to strengthen the ties with the NZ contingent of the ancestral health conference. I’m someone who values relationships over and above most things, and to be surrounded by like minded people is something that makes me feel energised and inspired. We made the most of being in one place to share meals, debrief the day’s events and get to know each other better. It also gave us the opportunity to discuss how the first bigger symposium of AHSNZ may look next year (as we’ve got another mini symposium organised for Labour weekend in Wanaka – more details to come.) I’m sure that Caryn and I weren’t the only ones to come away feeling that the work we are doing as practitioners and also at AUT is strengthening the ancestral health message.

We also got an opportunity to see what is on offer in the US market in the way of paleo-style snacks and supplements. A favourite for me was the Epic Bar – not for everyone, this meat and fruit based protein bar is not unlike jerkey with a softer texture. It really hit the spot one morning when a sit down breakfast wasn’t going to happen. Equally the Exo bar was another eye opener – a protein bar made with crickets as opposed to whey protein – yep, not a typo. It was delicious but, then, anything that includes cacao powder and dates can probably cover up any questionable flavour that a crushed insect might taste like. I am unsure if either of these ship to NZ, but like most things I am sure that something similar will likely be available at some point. Of course in amongst the more ‘real food’ like options were the paleo treats (almond flour cupcake mixture, anyone?) however I would say there is always a place for these items and to give these smaller companies exposure at a conference with 500 attendees is a win-win. They directly target those who will be interested in purchasing, and the AHS is able to raise funds to run the conference. And those Hail Merry Macaroons are super tasty and deserve the exposure they get.

And, with that – I’m done. It is 6pm NZ time, 11pm LA time, I’m exhausted and I’ve managed to get through about 1/8th of what I wanted to share. Not particularly informative in itself, the main purpose of this is to link to other sites which can help inspire and inform as much as to give you my impression of the conference. I’m already planning on attending next year in Boulder, but more importantly, I’m just excited to be part of the AHSNZ team. For those who are interested in being involved, it’s not too long before general membership will be open. The more people we get involved, the further the ancestral health message will spread. In the meantime, get your tickets for the symposium in Wanaka on Labour weekend at Rippon Valley winery here.