Disclosures. Dr. Mohr serves as a consultant to Daisy Cottage Cheese Health Network and the National Dairy Council.

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

5 5 1 The Science of Muscle Metabolism

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

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

8 8 2 How Much Protein And When?

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

10 Biggest Health Risk of Too Much Protein 10

11 11 Synergistic Effect of Protein and Exercise * * Protein Synthesis (%/h) % increase 50% increase * * Young Elderly 0 Fasting Protein meal Protein + Exercise Symons et al, J Nutr Health Aging, 2011

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

13 13 3 Protein Distribution & Recommendations

14 14 But Don t We Already Eat Enough Protein? + =?

15 15 Protein consumed in Australia (grams per day) Males 5 th % 50 th % 95 th % Females I m glad I moved! McLennan and Podger, ABS and CDHAC, 1998

16 Protein consumed per meal (g) 16 National Health and Nutrition Examination Survey (NHANES) Total: ~ 88 g/day Breakfast Lunch Dinner Snacks

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

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

19 Catabolism Anabolism 19 Optimizing Protein Consumption maximum rate of protein synthesis 30 g 30 g 30 g Total Protein 90 g Usable Protein 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 20 Exercise/ Rehab and Protein Distribution Exercise: Catabolism Anabolism 30 g 30g 30 g Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care., 2009

21 30-gram Protein Breakfast ideas 21

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

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

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

25 25 4 Priority Areas: Aging, Inactivity, Illness

26 26 If You are Hospitalized- You are Put in Bed % Time Inactive (0 steps/min) Low Activity (< 15 steps/min)

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

28 28 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 Paddon-Jones et al, J Clin Endocrinol Metab., 2004; English et at, PhD Thesis, 2013 Elderly data from Kortebein, JAMA, 2007

29 Protein Synthesis (%/h) Inactivity Anabolic Resistance: rescued by protein? Day 1 Day 10 * 30% + amino acids Kortebein et al, JAMA, 2007

30 30 Leucine has a key regulatory role on muscle protein synthesis you probably don t need extra though

31 Conclusions and Recommendations 31

32 32 Immediate challenge: correct the absurd Breakfast Lunch Dinner

33 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 34 Recommendations: Prevention and Treatment React aggressively to develop a nutritional framework to reduce the rapid loss of muscle and strength associated with shortterm physical inactivity, illness or injury

35 Muscle mass (kg) 35 Uncomplicated Sarcopenia vs. Catabolic Crisis Model Age (yrs) English and Paddon-Jones, Curr Opin Clin Nutr Metab Care., 2010

36 Nutrition and Metabolism 36 Paddon-Jones Lab Emily Arentson-Lantz Jennifer Ellison Kirk English Sneha Nagamma Jean Gutierrez Medical Team Elena Volpi Rene Przkora Randall Urban James Pattarini 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 NR NSBRI (NNJ08ZSA002N) Texas Space Grant Consortium UTMB Claude D. Pepper Older Americans Independence Center (NIH)

37 37

38 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 give you as much protein as meat Eating breakfast is not beneficial Plant proteins are as good More is always better High protein diets are bad for your bones You need a TON of protein to see benefits

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

40 10-35% 40

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43 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 44 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 50 g total protein 13% protein

45 45 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 100 g total protein 26% protein

46 46 Where Do We Get Grams of Protein? 1 cup cottage cheese 1 cup Greek yogurt 1 scoop protein powder 2 oz Parmagiano cheese 3 oz beef jerky (about the size of your iphone) 4 oz beef 1 can/packet tuna or salmon 4 oz poultry 2 whole eggs + 4 egg whites 4 oz seafood

47 47 Protein Myths There s no way I can eat that much High protein diets High protein diets cause kidney problems cause kidney Beans & legumes give you as much protein as meat Eating breakfast is not beneficial Plant proteins are as good problems. More is always better High protein diets are bad for your bones You need a TON of protein to see benefits Everyone needs the same amount of protein Meal-replacement protein bars & shakes are identical High protein diets make you crave sweets

48 Take Away 48

49 49

50 50 Choose Lose

51 51 Optimal Protein Range 40 AMDR UPPER RANGE: 35% 30 OPTIMAL: 25% - 30% AMDR LOWER RANGE 10% Age in Years

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