Hyperprotein Diets

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Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat. Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag.

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Hyperprotein Diets

  1. 1.
  2. 2. Hyperprotein Diets<br />Dr. Clarence P. Davis<br />Bergstrasse 8<br />CH-8702 Zollikon<br />
  3. 3. Dr. C.P. Davis<br />Subjects<br />General remarks on Obesity an associated riscs<br />Role of Protein in the Diet<br />Definition of high Protein Diets<br />High Protein Diets and Weight Reduction<br />Atkins, Zone, Protein Power, Sugar Busters, Stillman<br />
  4. 4. Dr. C.P. Davis<br />1991<br />Obesity Trends* Among U.S. AdultsBRFSS,1991, 1996, 2004<br />(BMI 30)<br />1996<br />2004<br />No Data &lt;10% 10%–14% 15%–19% 20%–24% ≥25%<br />Source: Centers for Disease Control and Prevention<br />
  5. 5. Dr. C.P. Davis<br />Obesity in Europe<br />Source: IOTF<br />women<br />men<br />Yugoslavia<br />Greece<br />Romania<br />Czech Rep.<br />England<br />Finland<br />Germany<br />Scotland<br />Slovakia<br />Portugal<br />Spain<br />Denmark<br />Belgium<br />Sweden<br />France<br />Italy<br />Netherlands<br />% BMI  30<br />Norway<br />Hungary<br />Switzerland<br />30<br />40<br />30<br />0<br />40<br />20<br />10<br />10<br />20<br />
  6. 6. Dr. C.P. Davis<br />Consequences of Obesity<br />cardiovascular diseases<br />gastro esophageal reflux<br />gallbladder disease<br />diabetes<br />osteoarthritis<br />cancer<br /><ul><li>breast
  7. 7. uterus
  8. 8. gallbladder
  9. 9. kidney
  10. 10. colon</li></ul>hormonal imbalances<br />hyperuricemia and gout<br />
  11. 11. Dr. C.P. Davis<br />Risks associated with Obesity<br />NIH/NHLBI The Practical Guide, Identification, Evaluation and Treatment of Overweight and Obesity in Adults, October 2000.<br />
  12. 12. Dr. C.P. Davis<br />Obesity and heart failure: cumulative incidence in women<br />BMI &gt;30kg/m2<br />BMI 25.0-29.9kg/m2<br />BMI 18.5-24.9kg/m2<br />Kenchaiah S et al N Engl J Med. 2002 Aug 1;347(5):305-13 <br />
  13. 13. Dr. C.P. Davis<br />Obesity and heart failure: cumulative incidence in men<br />BMI &gt;30 kg/m2<br />BMI 25.0-29.9kg/m2<br />BMI 18.5-24.9kg/m2<br />Kenchaiah S et al N Engl J Med. 2002 Aug 1;347(5):305-13 <br />
  14. 14. Dr. C.P. Davis<br />BMI and age related mortality<br />2.4<br />2.4<br />women<br />men<br />age<br />50-54<br />55-59<br />60-64<br />2.2<br />2.2<br />2.0<br />2.0<br />1.8<br />1.8<br />Relative risk<br />1.6<br />1.6<br />1.4<br />1.4<br />1.2<br />1.2<br />1.0<br />1.0<br />0.8<br />0.8<br />21<br />25<br />29<br />33<br />37<br />41<br />21<br />25<br />29<br />33<br />37<br />41<br />BMI (kg/m2)<br />BMI (kg/m2)<br />after Waaler HT Acta Med Scand Suppl. 1984;679:1-56<br />
  15. 15. Dr. C.P. Davis<br />The diet generation<br />~ 30% of all male and ~ 45% of all female US citizens are trying to lose weight<br />Diet books available on Amazon.com: ~ 38’000<br />Many of these books promote some sort of CHO restriction and hyperprotein diet<br />Dr. Atkins’ New Diet Revolution, The Carbohydrate Addict’s Diet, Protein Power, Lauri’s Low-Carb Cookbook<br />
  16. 16. Dr. C.P. Davis<br />Important Questions<br />What is really known about CHO restriction? Is the information scientifically sound?<br />What is the effect on composition of<br />weight loss (fat vs. LBM)<br />micronutrient status (vitamins and minerals)<br />metabolic parameters (blood glucose, insulin sensitivity, blood pressure, lipid levels, uric acid, ketone bodies)?<br />
  17. 17. Dr. C.P. Davis<br />Role of Protein in the Diet<br />Proteins are essential components of the body and are required for the body’s structure and proper function<br />Enzymes, hormones, antibodies, transport and structural components<br />The nutritional quality of food proteins varies and depends on essential amino acid composition (egg white = biological value of 100)<br />Foods with high protein quality are from animal source<br />eggs, milk, meat, poultry, fish<br />
  18. 18. Dr. C.P. Davis<br />Role of Protein in the Diet<br />In the US an average of 102 g of protein per person per day is available in the food supply<br />Actual protein consumption ranges from 88 to 92 g for men and 63 to 66 g for women (12-15 % of total daily energy uptake)<br />Animal products provide ~ 75% of the essential amino acids in the food supply, followed by dairy products, cereal products, eggs, legumes, fruits, and vegetables<br />The RDA for protein of high biological value for adults is ~ 0.8 g/kg BW (~ 8-10% of total daily energy uptake)<br />
  19. 19. Dr. C.P. Davis<br />Definition of high protein diets<br />High protein diets: &gt;20% of total energy<br />Very high protein diets: &gt;30% of total energy<br />
  20. 20. Dr. C.P. Davis<br />Protein Intake at Various Levels of Energy Intake<br />St. Jeor ST, Ashley JM. In: Obesity: Impact on Cardiovascular Disease. 1999:233-246.<br />
  21. 21. Dr. C.P. Davis<br />Compensatory Changes in the Macronutrient Composition of Various Diets<br />
  22. 22. Dr. C.P. Davis<br />Some popular Diets<br />Atkins<br />Eating too many CHO causes obesity and other health problems; ketosis leads to decreased hunger<br />Meat, fish, poultry, eggs, cheese, low-CHO vegetables, butter, oil; no alcohol<br />Protein: 27%, CHO: 5%, Fat: 68% (saturated 26%)<br />No long term validated studies published<br />Initial weight loss mostly water. Difficult to maintain long-term because diet restricts food choices<br />
  23. 23. Dr. C.P. Davis<br />Some popular Diets<br />Zone (Montignac)<br />Eating the right combination of foods leads to metabolic state at which body functions at peak performance, leading to decreased hunger, weight loss, and increased energy<br />Protein, fat, CHO must be eaten in exact proportions (40/30/30). Low-glycemic-index foods, alcohol in moderation<br />Protein: 34%, CHO: 36%, Fat: 29% (saturated 9%), Alcohol: 1%<br />No long term validated studies published. Theories highly questionable.<br />Weight loss based on caloric restriction. Could result in weight maintenance if carefully followed. Diet rigid and difficult to maintain.<br />
  24. 24. Dr. C.P. Davis<br />Some popular Diets<br />Protein Power<br />Eating CHO releases insulin in large quantities, which contributes to obesity and other health problems<br />Meat, fish, poultry, eggs, cheese, low-CHO vegetables, butter, oil, salad dressings, alcohol in moderation<br />Protein: 26%, CHO: 16%, Fat: 54% (saturated 18%), Alcohol: 4%<br />No long term validated studies published <br />Weight loss based on caloric restriction. Limited food choices not practical for long term.<br />
  25. 25. Dr. C.P. Davis<br />Some popular Diets<br />Stillman<br />High-protein foods burn body fat. If CHO are consumed, the body stores fat instead of burning it<br />Lean meats, skinless poultry, lean fish and seafood, eggs, cottage cheese, skim-milk products; no alcohol<br />Protein: 64%, CHO: 3%, Fat: 33% (saturated 13%)<br />No long term validated studies published <br />Initial weight loss mostly water. Maintenance based on strict caloric counting. Very limited food choices not practical for long term.<br />
  26. 26. Dr. C.P. Davis<br />Comparison of various diets with regard to Body Fat, Body Protein and Body Water<br />The best results were achieved with a combination of 50 g of proteins, 25 g CHO, and 10 g of fat<br />Wechsler JG et al. Fortschr Med. 1984 Jun 28;102(24):666-8<br />
  27. 27. Dr. C.P. Davis<br />Effects of HPD<br />Skov et al. Int J Obes Relat Metab Disord. 1999; 23:528-536<br />65 healthy overweight men and women<br />2 ad lib fat reduced (&lt; 30% kcal) diets varying in protein content (12% vs 25% of kcal) over 6 months<br />Larger weight loss with higher-protein diet (8.9 kg) vs lower-protein diet (5.1 kg)<br />Larger fat loss with higher-protein diet (7.6 kg) vs lower-protein diet (4.3 kg)<br />
  28. 28. Dr. C.P. Davis<br />Effects of HPD<br />On average, consumption of HPD and/or low-CHO diets resulted in 12-wk and 24-wk weight losses that were 2.5 ± 1.8 and 4.0 ± 0.4 kg greater, respectively, than those from consumption of the high CHO and/or low-fat control diets.<br />This implies a 233 kcal/day difference in energy balance<br />
  29. 29. Dr. C.P. Davis<br />Effects of HPD<br />Two possible hypotheses for difference in energy balance<br />1) a low-CHO diet may increase energy expenditure<br />2) an increase in protein in the diet may increase energy expenditure <br />
  30. 30. Dr. C.P. Davis<br />Do Proteins increase Energy Expenditure?<br />Mikkelsen et al. Am J Clin Nutr. 2000; 72:1135:1141<br />Ad lib diet<br />Increase of protein from 11% to 28/29%<br />No change in fat (29%)<br />Reduction of CHO from 60% to 42/43%<br />Increase in energy expenditure by about 60 – 120 kcal/24 hour, depending on whether the protein was of plant or animal origin <br />
  31. 31. Dr. C.P. Davis<br />Do Proteins increase Energy Expenditure?<br />Whitehead JM et al. Int J Obes Relat Metab Disord. 1996; 20:727-732<br />50% energy restricted diet<br />Increase of protein from 15 – 36%<br />Compared with the weight-maintenance control diet both diets resulted in a reduction of 24-hour energy expenditure<br />Smaller reduction for higher-PD by 71 kcal/d compared with the lower-PD<br />Lesser decrease of resting metabolic rate<br />Lesser decrease of thermic effect of food<br />
  32. 32. Dr. C.P. Davis<br />Do Proteins increase Energy Expenditure?<br />Not sure<br />Small results cannot explain the effect of the average 2.5 kg greater weight loss reported from low-CHO diets<br />
  33. 33. Dr. C.P. Davis<br />Reasons for higher Weight loss with HPD<br />Dietary compliance<br />Difficult to document<br />Some evidence from comparative studies with low-fat diets vs. low-CHO/HPD and theoretical weight loss<br />Possible higher satiating effect of proteins<br />
  34. 34. Dr. C.P. Davis<br />Mean Self-reported Dietary Adherence Scores of All 4 Diet Groups, According to Study Month<br />CHO-restriction<br />Glucose-restriction<br />Fat-restriction<br />Calorie-restriction<br />Comparison of different diets with respect to compliance<br />Dansinger ML et al. JAMA. 2005 Jan 5;293(1):43-53<br />
  35. 35. Dr. C.P. Davis<br />One-Year Changes in Body Weight as a Function of Diet Group and Dietary Adherence Level for All Study Participants<br />Comparison of different diets with respect to weight loss<br />Dansinger ML et al. JAMA. 2005 Jan 5;293(1):43-53<br />
  36. 36. Dr. C.P. Davis<br />Reasons for higher Weight loss with HPD<br />Limitation of food choices associated with low-CHO diets<br />Low-CHO diets induce small losses of body water (~ 1.5-2 kg)<br />Does not explain the difference generally reported for comparisons of low-CHO and low-fat diets<br />1.9 kg is lesser than reported<br />Greater weight loss is reported to be based on fat loss not water<br />
  37. 37. Dr. C.P. Davis<br />Limitations of current studies and outlook<br />Very few “pure” studies on HPD<br />Impossibility of manipulating one macronutrient without changes in at least one other macronutrient<br />Studies on energy expenditure may not give the right picture<br />Too short time frame<br />Weight losses found in 12 weeks may not be representative of long-term effect<br />
  38. 38. Dr. C.P. Davis<br />Comparison of Weight Loss<br />Foster GD et al. N Enlg J Med 2003 22;348(21):2082-90<br />
  39. 39. Dr. C.P. Davis<br />Urinary Ketosis<br />Foster GD et al. N Enlg J Med 2003 22;348(21):2082-90<br />
  40. 40. Dr. C.P. Davis<br />Limitations of current studies and outlook<br />Usually studies investigate only one side of the energy balance equation<br />Health issues are rarely investigated<br />The amount of protein recommended in HPD exceeds established requirement and may impose significant health risks<br />Little cross-sectional and longitudinal studies provide data on health effects of HPD<br />
  41. 41. Dr. C.P. Davis<br />Risks associated with HPD<br />Animal protein, saturated fat, and cholesterol raises LDL-cholesterol<br />HPD increase purine levels<br />gout<br />HPD increase urinary calcium loss<br />osteoporosis<br />Deficiencies in essential vitamins, minerals, and fibers<br />Increased cancer risk<br />low phytochemical)<br />VHPD with excessive limitations of CHO may lead to loss of lean muscle tissue (glyconeogenesis)<br />Larosa JC et al. J Am Diet Assoc 1980; 77:264-270<br />Franzese TA. In: Kause‘s Food, Nutrition, & Diet Therapy. 2000:970-986<br />Barzel US et al. J Nutr 1998; 128:1051-1053<br />Costill DL et al. Sports Med 1992; 13:86-92<br />
  42. 42. Dr. C.P. Davis<br />High-protein Diets and Weight Reduction<br />Weight reduction is achieved if there is an energy deficit (energy uptake &lt; energy expenditure)<br />In obese individuals, macronutrient composition has little effect on the rate or magnitude of weight loss unless nutrient composition influences caloric intake<br />Overall caloric intake depends on palatability and satiety<br />Proteins are easily available, palatable and of high essentiality<br />
  43. 43. Dr. C.P. Davis<br />High-protein Diets and Weight Reduction<br />High-protein diets are initially attractive<br />quick weight loss due to low CHO intake, glycogen depletion, and ketosis<br />High-protein diets usually induce metabolic ketosis<br />Ketosis may lead to lower caloric intake<br />VHPD may promote negative energy balance due to significant food restrictions<br />
  44. 44. Dr. C.P. Davis<br />High-protein Diets and Weight Reduction<br />The structured eating plan, strict eating schedules, and limited tolerance for high-protein foods reduce overall flexibility but offer initial appeal. These characteristics may help limit caloric intake and may account for weight loss. However, neither the efficacy of these diets compared with higher COH diets in promoting weight loss nor the safety of these diets has been documented in long-term studies.<br />St. Jeor ST et al. Circulation 2001; 104; 1869-1874<br />
  45. 45. Dr. C.P. Davis<br />General Recommendation for HPD<br />The current evidence, combined with the need to meet all nutrient requirements, suggests that weight-loss diets should be moderate in CHO, moderate in fat, and that protein should possibly contribute one fourth to one third of energy intake.<br />

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