CIA-Harvard Menus of Change National Leadership Summit. Protein PDF Free Download

CIA-Harvard Menus of Change National Leadership Summit June 10, 2014 Cambridge, MA General Session III Protein 101 Christopher Gardner, PhD, Professor of Medicine, Stanford Prevention Research Center, Stanford University

Protein 101

Outline Standard Recommendations Minimum / Optimal / Maximum CONFUSION? Quality Impact of Shifting from Animal to Plant-Based Proteins

Dietary Reference Intakes (DRI) Dietary Guidelines for Americans

PROTEIN: Estimated Average Requirement (EAR) Grams / kg body weight Age Group 7-12 months 1-3 years 4-8 years 9-13 years 14-18 years >18 years Girls/Women 1.0 0.87 0.76 0.76 0.71 0.66 Boys/Men 1.0 0.87 0.76 0.76 0.73 0.66

PROTEIN: Estimated Average Requirement (EAR) > 18 years 0.66 Grams / kg body weight Weight (lbs) 100 150 200 250 EAR 30 g 45 g 60 g 75 g

Distribution of Requirement Protein Requirement 25 grams/day 54 grams/day

Recommended Daily Allowance (RDA) Population Approach: Add 2 Standard deviations to EAR Protein Requirement 25 grams/day 54 grams/day

PROTEIN: Recommended Daily Allowance (RDA) Grams / kg body weight Age Group 7-12 months 1-3 years 4-8 years 9-13 years 14-18 years >18 years Girls/Women 1.2 1.05 0.95 0.95 0.85 0.80 Boys/Men 1.2 1.05 0.95 0.95 0.85 0.80

PROTEIN: Recommended Daily Allowance (RDA) > 18 years 0.8 Grams / kg body weight Weight (lbs) 100 150 200 250 RDA 36 g 55 g 73 g 91 g

Recommended vs. Actual Intake in U.S. RDA for protein for adults >18 years Women: 46 g/day Men: 58 g/day Daily estimated intake of protein by Americans 85% from animal sources 111 g/day Does not account for the cumulative amounts of protein from minor protein sources The data are from (e.g., 2006, potatoes, based on data published vegetables) in 2011, and accessed April 28, 2014. (http://www.ers.usda.gov/dataproducts/food-availability-%28per-capita%29-data-system/.aspx#.u168mlfiisp) https://fnic.nal.usda.gov/food-composition/usda-nutrient-data-laboratory)

grams 300 250 PROTEIN Intake Stanford Students Range: 39-263 grams Mean (+/- SD) = 99 +/- 39 grams 200 150 100 50 0 Average requirement?? RDA for men ~55 grams RDA for women ~45 grams

Class Exercise: Protein and Energy (Kcal) intake 300 250 PROTEIN Intake Stanford Med Students Protein (grams) 200 150 100 50 0 0 1000 2000 3000 4000 Kcals

Class Exercise: Protein and Energy (Kcal) intake Protein (grams) 300 250 200 150 PROTEIN Intake Stanford Med Students Likely under-reporting average intake for typical day, unless actively losing weight 100 50 0 0 1000 2000 3000 4000 Kcals

Class Exercise: Protein and Energy (Kcal) intake 300 250 PROTEIN Intake Stanford Med Students Protein (grams) 200 150 100 50 EAR 0 0 1000 2000 3000 4000 Kcals

Class Exercise: Protein and Energy (Kcal) intake 300 250 PROTEIN Intake Stanford Med Students Protein (grams) 200 150 100 50 RDA EAR 0 0 1000 2000 3000 4000 Kcals

% Protein Class Exercise: Protein and Energy (Kcal) intake 40% 35% PROTEIN Intake Stanford Med Students 30% 25% 20% 15% 10-25% 10% 5% 0% 0 500 1000 1500 2000 2500 3000 3500 4000 Kcal

Outline Standard Recommendations Minimum / Optimal / Maximum CONFUSION? Protein Quality Impact of Shifting from Animal to Plant-Based Proteins

JAMA, June 25, 2008 Vol 299, No. 24 pp 2891-2893

JAMA, June 25, 2008 Vol 299, No. 24 pp 2891-2893 The recommended dietary allowance (RDA) is an estimate of the minimum daily average dietary intake level that meets the nutrient requirements of nearly all (97 to 98 percent) healthy individuals. the minimum protein intake necessary to avoid a progressive loss of lean body mass as reflected by nitrogen balance.

Acceptable macronutrient distribution ranges (AMDR) Percentages of daily calories from carbohydrate, fat and protein sufficient to provide adequate total energy intake and nutrients while reducing the risk of chronic disease. 10-35% Protein 45-65% Carbohydrate 20-35% Fat IOM Dietary Reference Intakes

Acceptable macronutrient distribution ranges (AMDR) Percentages of daily calories from carbohydrate, fat and protein sufficient to provide adequate total energy intake and nutrients while reducing the risk of chronic disease. 10-35% Protein 10% of a typical caloric intake translates to 0.95 g/kg/d and 35% of energy intake translates to 3.3 g/kg/d. IOM Dietary Reference Intakes

Athletes and active individuals may benefit from protein intakes of 1.2 to 1.7 g/kg/d, an amount higher than the recommended daily allowance of 0.8 g/kg/d.

Health (%) OPTIMAL intake is typically a wide range Bounded by marginal deficiency and toxicity

Outline Standard Recommendations Minimum / Optimal / Maximum CONFUSION? Protein Quality Impact of Shifting from Animal to Plant-Based Proteins

Amino Acids Essential Histidine Isoleucine Leucine Lysine Methionine Phenylalanine Threonine Tryptophan Valine Nonessential Alanine Arginine Asparagine Aspartic acid Cysteine Glutamic acid Glutamine Glycine Proline Serine Tyrosine

How Many Amino Acids? Insulin: ~50 amino acids Lipoprotein lipase (LPL): ~450 amino acids Hemoglobin: ~600 amino acids Thyroglobulin: ~2,700 amino acids Titin: largest known protein ~34,350 amino acids

Food Proteins: Quality, Use, and Need Limiting Amino Acid Protein Quality The essential amino acid that is present in dietary protein in the lowest amount proportional to its requirement

Just as each letter that is part of a word must be present when forming that word, each amino acid that is part of a protein must be present when building that protein.

His Iso Leu Lys Met Phe Thr Trp Val Ala Arg Asp/ine Cys Glut/ine Gly Pro Ser Tyr grams Amino Acid Distribution (per 40 grams protein): EGG 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Essential Non-Essential

His Iso Leu Lys Met Phe Thr Trp Val Ala Arg Asp/ine Cys Glut/ine Gly Pro Ser Tyr grams Amino Acid Distribution (per 40 grams protein): EGG 6.0 10-fold difference 5.0 4.0 3.0 2.0 1.0 7-fold difference 0.0 Essential Non-Essential

His Iso Leu Lys Met Phe Thr Trp Val Ala Arg Asp/ine Cys Glut/ine Gly Pro Ser Tyr grams Amino Acid Distribution (per 40 grams protein) 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Whole Egg White Rice Essential Non-Essential

His Iso Leu Lys Met Phe Thr Trp Val Ala Arg Asp/ine Cys Glut/ine Gly Pro Ser Tyr grams Amino Acid Distribution (per 40 grams protein) 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Limiting amino acid Whole Egg White Rice Essential Non-Essential

His Iso Leu Lys Met Phe Thr Trp Val Ala Arg Asp/ine Cys Glut/ine Gly Pro Ser Tyr grams Amino Acid Distribution (per 40 grams protein) 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Limiting amino acid Whole Egg Pinto Beans Essential Non-Essential

His Iso Leu Lys Met Phe Thr Trp Val Ala Arg Asp/ine Cys Glut/ine Gly Pro Ser Tyr grams Amino Acid Distribution (per 40 grams protein) 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Limiting amino acid Whole Egg Beans and Rice Essential Non-Essential

Outline Standard Recommendations Minimum / Optimal / Maximum CONFUSION? Protein Quality Impact of Shifting from Animal to Plant-Based Proteins

the source of protein (90 percent animal, 90 percent vegetable, or mixed) did not significantly affect the median nitrogen requirement, slope, or intercept. It should be noted that almost all of the studies included as 90 percent vegetable were based on complementary proteins.

Food Proteins: Quality, Use, and Need Concern about the quality of individual food proteins is of only theoretical interest in settings where food is abundant. Most people in the US and Canada eat a variety of nutritious foods to meet their energy needs not just say, cookies, potato chips or alcoholic beverages. They would find it next to impossible not to meet their protein requirements, even if they were to eat no meat, fish, poultry, eggs, cheese or soy products. Sizer and Whitney, Nutrition Concepts and Controversies

One of my vegan days Breakfast 1 c Steel cut oats ¼ c Unswtnd soy milk ⅓ c Walnuts ¾ c Mango ⅓ c Unswtnd soy milk 4 oz coffee Snack ¼ c Trail Mix Lunch SALAD Mixed lettuce, edamame, pinto beans, garbanzo beans, tofu, carrots, jicama, sunflower seeds, beets, potatoes, slivered almonds, olive oil, balsamic vinegar Snack Apple 1 oz Dark Chocolate 12 oz Soy chai Dinner 2 c Gypsy Soup (Sweet potatoes, chickpeas, veggies, turmeric) 1/8 c Cashews 1 slice Whole grain bread 6 spears Asparagus Snack 1 oz Dark Chocolate ⅓ c Unswtnd soy milk 4 oz coffee

One of my vegan days Item 2 c Gypsy Soup 1.75 c Soy milk 2 Tblsp Edamame ¼ c Trail Mix 1/3 c Walnuts 1 c Steel cut oats 2 Tblsp Pinto beans 2 Tblsp Garbanzo beans 1 slice Whole grain bread 2 Tblsp Slivered almonds Kcal 431 120 63 175 190 202 61 67 70 78 Protein (g) 13 12 5.6 5.2 4.4 7.0 3.9 3.6 3.6 2.9 Subtotal 61 g 2 oz Dark Chocolate 1/8 c Cashews 6 spears Asparagus 1 Tblsp Sunflower Seeds 3 c Mixed greens 1/16 c tofu 340 95 20 52 25 12 4.4 2.7 2.2 1.8 1.8 1.3 14 g Mango, apple, beets potato, chai tea, carrots, jicama, balsamic vinegar, olive oil 488 3 61 + 14 + 3 = 78 g

Protein Use

Protein Use 1. Functional Protein

Protein Use 1. Functional No Storage Protein

Protein Use 1. Functional No Storage Protein 2. Carbohydrate (for immediate need, or conversion to glycogen)

Protein Use 1. Functional No Storage Protein 2. Carbohydrate (for immediate need, or conversion to glycogen) 3. Fat (conversion for energy storage)

Protein Use 1. Functional No Storage Protein Nitrogen 2. Carbohydrate (for immediate need, or conversion to glycogen) 3. Fat (conversion for energy storage)

Protein Use 1. Functional No Storage Protein Nitrogen NH3 (Ammonia) 2. Carbohydrate (for immediate need, or conversion to glycogen) 3. Fat (conversion for energy storage)

Take Home Points Standard Recommendations Minimum / Optimal / Maximum CONFUSION? Quality Impact of Shifting from Animal to Plant-Based Proteins

Take Home Points Standard Recommendations Minimum / Optimal / Maximum CONFUSION? Quality Impact of Shifting from Animal to Plant-Based Proteins Americans (justifiably) confused about HOW MUCH protein they need, and from WHAT SOURCES to get it In general, they get a LOT, and with some qualifiers, a LOT MORE THAN THEY NEED

Measuring Protein Quality Protein digestibility - corrected amino acid score: PDCAAS (100=perfect/best) Egg white - 100 Ground beef - 100 Chicken products - 100 Fat free milk - 100 Tuna fish 100 Soybean 94 Most legumes 50 s and 60 s Gluten (wheat protein) 25 Pea flour (67) + whole wheat flour (40) - 82

Protein requirement and recommendations How much protein do people really need? PROTEIN RECOMMENDATIONS (Table 6.2, page 197) DRI: 0.8 g / kg / day (women ~46 g/day, men ~56 g/day) Dietary Guidelines: Every day 5 to 6-1/2 oz equivalents of legumes, nuts, seeds, eggs, lean poultry without skin, or lean meat. Every day 3 cups fat-free or low-fat milk or yogurt, or fortified soy beverage Eat a variety of foods to provide protein from other sources Daily Value (for 2,000 calories/day): 50 grams/day World Health Organization: 10-15% of daily calories DRI AMDR (2002): 10-35% of daily calories

4 oz Tenderloin Beef Calories Protein (g) Fat (g) Saturated fat (g) Carbs (g) Added sugar (g) Fiber (g) ~200 32 7.5 3 0 0 0

4 oz Hamburger patty Calories Protein (g) Fat (g) Saturated fat (g) Carbs (g) Added sugar (g) Fiber (g) ~210 22 13 ~5 0 0 0

4 oz Chicken Breast Calories Protein (g) Fat (g) Saturated fat (g) Carbs (g) Added sugar (g) Fiber (g) ~120 24 1.5 0.5 0 0 0

4 oz Salmon Calories Protein (g) Fat (g) Omega-3 fat (g) Carbs (g) Added sugar (g) Fiber (g) ~185 32 5.5 ~2 0 0 0

Two eggs Calories Protein (g) Fat (g) Sat fat (g) Carbs (g) Added sugar (g) Fiber (g) ~150 13 10 3 <1 0 0

What is in 8 oz of the different types of milk? Calories Fat Carbs Protein 150 8 g 11 g 9 g 2% 140 5 g 14 g 10 g 120 3 g 14 g 10 g 100 <1 g 14 g 10 g

Plain (Low-Fat) Yogurt Calories Protein (g) Fat (g) Sat fat (g) Carbs (g) Added sugar (g) Fiber (g) ~90 7 2 1 11 0 0

What is in 8 oz of different types of SOY milk? Calories Fat Carbs Protein 100 3.5 g 10 g 6 g 100 4 g 8 g 7 g 80 4 g 4 g 7 g

1/2 cup Edamame Calories Protein (g) Fat (g) Sat fat (g) Carbs (g) Added sugar (g) Fiber (g) ~120 12 7 1 12 0 4

Beans ½ cup cooked Kcal Protein Carb Fiber Fat Sat Fat Lentils Garbanzos Kidney Pinto 115 9 g 20 g 8 g 0.4 g 0.1 g 135 7 g 22 g 6 g 2 g 0.4 g 112 6 g 20 g 6 g 0.4 g 0 g 112 7 g 22 g 7 g 0.5 g 0 g

Nuts 1 ounce Kcal Protein Carb Fiber PUFA MUFA Sat Fat Almonds Cashews Walnuts Pistachios 170 5.9g 5.7g 3.5g 3.3g 9.0g 1.0 160 5.2g 8.5g 0.9g 2.2g 6.8g 2.2 175 6.8g 2.8g 1.9g 9.9g 4.2g 1.0 160 5.8g 7.9g 2.9g 3.8g 6.6g 1.5

1 slice Whole Grain Bread Calories Protein (g) Fat (g) Sat fat (g) Carbs (g) Added sugar (g) Fiber (g) ~65 2.6 1 0.2 12 varies 1-4

1 cup Broccoli Calories Protein (g) Fat (g) Sat fat (g) Carbs (g) Added sugar (g) Fiber (g) ~55 4 0.6 0 11 0 5

1 cup Romaine Calories Protein (g) Fat (g) Sat fat (g) Carbs (g) Added sugar (g) Fiber (g) ~10 0.5 0 0 <1 0 1

Protein Requirement (g/kg/day) FIGURE 10-5 Distribution of the estimated protein requirement for 225 individuals (Rand et al., 2003) in a trimmed data set showing the skewness of protein requirement. SOURCE: William Rand, personal communication, 2002.

The advantages of legumes (beans) Soy protein quality and quantity is high Legumes (beans) are excellent sources of: Fiber B-vitamins Iron Calcium And other minerals Legumes (beans) are not good sources of: Vitamins A, C or B12

2011

2011 MyPlate.gov

The USDA Food Guide Pyramid

Beans, Nuts, Fish, Eggs, Poultry, Meat CONTRIBUTE: Protein, fiber B6, B12, niacin, thiamin, folate, Vitamin E Potassium, zinc, magnesium, iron

Beans, Nuts, Fish, Eggs, Poultry, Meat CONTRIBUTE: Protein, fiber B6, B12, niacin, thiamin, folate, Vitamin E Potassium, zinc, magnesium, iron 2-3 servings/day

Beans, Nuts, Fish, Eggs, Poultry, Meat 2-3 servings/day CONTRIBUTE: Protein, fiber B6, B12, niacin, thiamin, folate, Vitamin E Potassium, zinc, magnesium, iron 1 Serving equals 1/2 cup cooked beans 1/3 cup nuts 2 tbs peanut butter 2-3 oz lean fish poultry meat (5-7 oz/day)

Beans, Nuts, Fish, Eggs, Poultry, Meat Fish, legumes, tempeh, peanut butter, nuts, seeds, eggs, poultry (no skin), lean meat Bacon, ground beef, hot dogs, sausages, spare ribs, luncheon meats, marbled steaks Make lean or low-fat choices

Milk, Yogurt and Cheese CONTRIBUTE: Protein Riboflavin & B12 (Vitamins A & D when fortified) Calcium, magnesium, potassium

Milk, Yogurt and Cheese CONTRIBUTE: Protein Riboflavin & B12 (Vitamins A & D when fortified) Calcium, magnesium, potassium 2-4* servings/day

Milk, Yogurt and Cheese 2-4* servings/day CONTRIBUTE: Protein Riboflavin & B12 (Vitamins A & D when fortified) Calcium, magnesium, potassium * 3 servings/day for: Teenagers Young adults Pregnant/lactating Postmenopausal women 4 servings/day for: Pregnant or lactating teenagers

Milk, Yogurt and Cheese 2-4* servings/day CONTRIBUTE: Protein Riboflavin & B12 (Vitamins A & D when fortified) Calcium, magnesium, potassium 1 Serving equals 1 cup milk or yogurt 1-1/2 oz cheese 2 oz processed cheese food

Milk, Yogurt and Cheese Fat-free milk, fat-free milk products (e.g., buttermilk, cheeses, cottage cheese, yogurt), fat free fortified soy milk Ice cream, whole milk, milk shakes, milk products with added sugar Make fat-free or low-fat choices

His Iso Leu Lys Met Phe Thr Trp Val Ala Arg Asp/ine Cys Glut/ine Gly Pro Ser Tyr grams Amino Acid Distribution Whole Egg: 40 g protein White Rice: 80 g protein 16 14 12 10 8 6 4 2 0 Limiting amino acid Essential Non-Essential

Protein Content Amount Protein (g) Kcal Egg 1 5.5 65 White Rice 1 cup 4.4 242 Pinto Beans 1 cup 15 245 Soy Beans 1 cup 33 375

Protein Content (cooked) Eggs White Rice Pinto Beans Soy Beans Amount providing 40 g protein 7.2 eggs 9 cups 2.6 cup 1.2 cups Kcal ~470 ~2,200 ~635 ~450

CIA-Harvard Menus of Change National Leadership Summit. Protein 101