1

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

2

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

The Science of Muscle Metabolism

5

1

Exerc

ise

An

ab

olic

the

rap

ies

Inflammation

Disease

Inactivity

Mitochondrial

Dysfunction

Inadequate

Nutrition

Aging

Blood Flow

Conceptual Model…

6

3

Artery

Vein

Stable Isotope Methodology (ring - 13C6 - Phenylalanine)

Synthesis

Breakdown

7

How Much Protein – And When?

8

2

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

thes

is (

%/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

4

Biggest Health Risk of Too Much Protein…

10

* *

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

Fasting Protein meal

Pro

tein

Syn

thesis

(%

/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

Ne

t M

usc

le P

rote

in S

ynth

esis

(m

g P

he/

leg)

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

5

Protein Distribution & Recommendations

13

3

…But Don’t We Already Eat Enough Protein?

14

+ = ?

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

6

0

5

10

15

20

25

30

35

40

45

Breakfast Lunch Dinner Snacks

Pro

tein

co

nsu

med

per

mea

l (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

18

Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care., 2009

7

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

nab

olis

m

30 g 30g 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

21

8

Protein Distribution Impacts Muscle Protein Synthesis

22

Mamerow et al, J Nutr., 2014

***

Older (?)

* *

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

9

Priority Areas: Aging, Inactivity, Illness

25

4

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 le

g m

as

s (

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

27

10

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

Syn

the

sis

(%

/h)

* 30%

Kortebein et al, JAMA, 2007

+ amino acids

Inactivity Anabolic Resistance: rescued by protein?

29

Leucine has a key regulatory role on

muscle protein synthesis

…you probably

don’t need extra though

30

11

Conclusions and Recommendations

31

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

12

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

15

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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13

37

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

14

10 - 35%

40

41

42

15

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 • 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

16

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

48

Take Away

17

49

Choose Lose

50

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

18

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