cia-harvard menus of change national leadership summit · 2014-06-16 · the recommended dietary...

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

http://www.foodpolitics.com/wp-content/uploads/DG.png

PROTEIN: Estimated Average Requirement (EAR)

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

Grams / kg body weight

Boys/Men 1.0

0.87

0.76

0.76

0.73

0.66

PROTEIN: Estimated Average Requirement (EAR)

Weight (lbs) 100

150

200

250

0.66 Grams / kg body weight

EAR 30 g

45 g

60 g

75 g

> 18 years

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)

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

Grams / kg body weight

Boys/Men 1.2

1.05

0.95

0.95

0.85

0.80

PROTEIN: Recommended Daily Allowance (RDA)

Weight (lbs) 100

150

200

250

0.8 Grams / kg body weight

RDA 36 g

55 g

73 g

91 g

> 18 years

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

111 g/day 85% from animal sources

Does not account for the cumulative amounts of protein from minor protein

sources (e.g., potatoes, vegetables)

The data are from 2006, based on data published in 2011, and accessed April 28, 2014. (http://www.ers.usda.gov/data-products/food-availability-%28per-capita%29-data-system/.aspx#.U168mlfiiSp)

https://fnic.nal.usda.gov/food-composition/usda-nutrient-data-laboratory)

http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/.aspx%23.U168mlfiiSp













https://fnic.nal.usda.gov/food-composition/usda-nutrient-data-laboratory









0

50

100

150

200

250

300 g

ram

s

PROTEIN Intake – Stanford Students

Range: 39-263 grams

Mean (+/- SD) = 99 +/- 39 grams

RDA for men ~55 grams

RDA for women ~45 grams

Average requirement??

0

50

100

150

200

250

300

0 1000 2000 3000 4000

Protein (grams)

Kcals

Class Exercise: Protein and Energy (Kcal) intake

PROTEIN Intake – Stanford Med Students

0

50

100

150

200

250

300

0 1000 2000 3000 4000

Protein (grams)

Kcals

Likely under-reporting

average intake for typical

day, unless actively

losing weight



0

50

100

150

200

250

300

0 1000 2000 3000 4000

Protein (grams)

Kcals

EAR



0

50

100

150

200

250

300

0 1000 2000 3000 4000

Protein (grams)

Kcals

RDA EAR




0%

5%

10%

15%

20%

25%

30%

35%

40%

0 500 1000 1500 2000 2500 3000 3500 4000

% P

rote

in

Kcal

10- 25%



Minimum / Optimal / Maximum –

CONFUSION?

Protein Quality


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 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

IOM – Dietary Reference Intakes

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.

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.

Healt

h (

%)

OPTIMAL intake is typically a wide range

Bounded by marginal deficiency and toxicity



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

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

How Many Amino Acids?

Food Proteins: Quality, Use, and Need

Protein Quality

Limiting Amino Acid

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.

0.0

1.0

2.0

3.0

4.0

5.0

6.0 H

is

Iso

Le

u

Lys

Me

t

Ph

e

Th

r

Trp

Va

l

Ala

Arg

As

p/in

e

Cys

Glu

t/in

e

Gly

Pro

Se

r

Tyr

gra

ms

Essential Non-Essential

Amino Acid Distribution (per 40 grams protein): EGG

0.0

1.0

2.0

3.0

4.0

5.0

6.0 H

is

Iso

Le

u

Lys

Me

t

Ph

e

Th

r

Trp

Va

l

Ala

Arg

As

p/in

e

Cys

Glu

t/in

e

Gly

Pro

Se

r

Tyr

gra

ms


7-fold difference

10-fold difference

Amino Acid Distribution (per 40 grams protein): EGG

His

Iso

Le

u

Lys

Me

t

Ph

e

Th

r

Trp

Va

l

Ala

Arg

As

p/in

e

Cys

Glu

t/in

e

Gly

Pro

Se

r

Tyr

gra

ms


Amino Acid Distribution (per 40 grams protein)

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Whole Egg

White Rice

His

Iso

Le

u

Lys

Me

t

Ph

e

Th

r

Trp

Va

l

Ala

Arg

As

p/in

e

Cys

Glu

t/in

e

Gly

Pro

Se

r

Tyr

gra

ms



0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Whole Egg

White Rice

Limiting amino acid

His

Iso

Le

u

Lys

Me

t

Ph

e

Th

r

Trp

Va

l

Ala

Arg

As

p/in

e

Cys

Glu

t/in

e

Gly

Pro

Se

r

Tyr

gra

ms



Whole Egg

Pinto Beans

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Limiting amino acid

His

Iso

Le

u

Lys

Me

t

Ph

e

Th

r

Trp

Va

l

Ala

Arg

As

p/in

e

Cys

Glu

t/in

e

Gly

Pro

Se

r

Tyr

gra

ms



Whole Egg

Beans and Rice

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Limiting amino acid



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

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

One of my vegan days 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

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

2 oz Dark Chocolate

1/8 c Cashews

6 spears Asparagus

1 Tblsp Sunflower Seeds

3 c Mixed greens

1/16 c tofu

Mango, apple, beets

potato, chai tea, carrots, jicama,

balsamic vinegar, olive oil

One of my vegan days

Kcal 431

120

63

175

190

202

61

67

70

78

340

95

20

52

25

12

488

Protein (g) 13

12

5.6

5.2

4.4

7.0

3.9

3.6

3.6

2.9

4.4

2.7

2.2

1.8

1.8

1.3

3

Subtotal

61 g

14 g

61 + 14 + 3 = 78 g

(~2,525 Kcal)

Protein Use

Protein Use

Protein

1. Functional

Protein Use

Protein

1. Functional

No Storage

Protein Use

Protein

1. Functional

2. Carbohydrate (for immediate need, or

conversion to glycogen)

No Storage

Protein Use

Protein

1. Functional



3. Fat (conversion

for energy storage)

No Storage

Protein Use

Protein

1. Functional



3. Fat (conversion

for energy storage)

Nitrogen

No Storage

Protein Use

Protein

1. Functional



3. Fat (conversion

for energy storage)

Nitrogen

No Storage

NH3

(Ammonia)

Take Home Points Standard Recommendations


Quality




Quality


Americans (justifiably) confused about HOW MUCH protein they need, and from WHAT SOURCES to get it



Quality



In general, they get a LOT, and with some qualifiers, a LOT MORE THAN THEY NEED



Quality



In general, they get a LOT, and with some qualifiers, a LOT MORE THAN THEY NEED

Tremendous room for substantial shift from animal to plant protein

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

Calories

Protein (g)

Fat (g)

Saturated fat (g)

Carbs (g)

Added sugar (g)

Fiber (g)

4 oz Tenderloin Beef

~200

32

7.5

3

0

0

0

Calories

Protein (g)

Fat (g)

Saturated fat (g)

Carbs (g)

Added sugar (g)

Fiber (g)

4 oz Hamburger patty

~210

22

13

~5

0

0

0

Calories

Protein (g)

Fat (g)

Saturated fat (g)

Carbs (g)

Added sugar (g)

Fiber (g)

4 oz Chicken Breast

~120

24

1.5

0.5

0

0

0

Calories

Protein (g)

Fat (g)

Omega-3 fat (g)

Carbs (g)

Added sugar (g)

Fiber (g)

4 oz Salmon ~185

32

5.5

~2

0

0

0

Calories

Protein (g)

Fat (g)

Sat fat (g)

Carbs (g)

Added sugar (g)

Fiber (g)

Two eggs ~150

13

10

3

<1

0

0

2%

What is in 8 oz of the different types of milk?

Calories Fat Carbs Protein

150 8 g 11 g 9 g

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

Calories

Protein (g)

Fat (g)

Sat fat (g)

Carbs (g)

Added sugar (g)

Fiber (g)

1/2 cup Edamame

~120

12

7

1

12

0

4

Beans

½ cup

cooked

Kcal

Protein

Carb

Fiber

Fat

Sat Fat

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

Lentils Garbanzos Kidney Pinto

Almonds Cashews Walnuts Pistachios 1 ounce

Kcal

Protein

Carb

Fiber

PUFA

MUFA

Sat Fat

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

Nuts

Calories

Protein (g)

Fat (g)

Sat fat (g)

Carbs (g)

Added sugar (g)

Fiber (g)

1 slice Whole

Grain Bread ~65

2.6

1

0.2

12

varies

1-4

Calories

Protein (g)

Fat (g)

Sat fat (g)

Carbs (g)

Added sugar (g)

Fiber (g)

1 cup Broccoli

~55

4

0.6

0

11

0

5

Calories

Protein (g)

Fat (g)

Sat fat (g)

Carbs (g)

Added sugar (g)

Fiber (g)

1 cup Romaine

~10

0.5

0

0

<1

0

1

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.

Protein Requirement (g/kg/day)

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 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


2-3 servings/day



folate, Vitamin E

Potassium, zinc,

magnesium, iron


2-3 servings/day

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)



folate, Vitamin E

Potassium, zinc,

magnesium, iron


Make lean or low-fat choices

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

Milk, Yogurt and Cheese

CONTRIBUTE: Protein

Riboflavin & B12

(Vitamins A & D when

fortified)

Calcium, magnesium,

potassium


2-4* servings/day

CONTRIBUTE: Protein

Riboflavin & B12


fortified)

Calcium, magnesium,

potassium


2-4* servings/day

3 servings/day for: Teenagers

Young adults

Pregnant/lactating

Postmenopausal women

4 servings/day for: Pregnant or lactating

teenagers

*

CONTRIBUTE: Protein

Riboflavin & B12


fortified)

Calcium, magnesium,

potassium


2-4* servings/day

1 Serving equals 1 cup milk or yogurt

1-1/2 oz cheese

2 oz processed cheese

food

CONTRIBUTE: Protein

Riboflavin & B12


fortified)

Calcium, magnesium,

potassium


Make fat-free or low-fat choices

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

His

Iso

Le

u

Lys

Me

t

Ph

e

Th

r

Trp

Va

l

Ala

Arg

As

p/in

e

Cys

Glu

t/in

e

Gly

Pro

Se

r

Tyr

gra

ms


Amino Acid Distribution

0

2

4 6

8

10

12 14

16

Whole Egg: 40 g protein

White Rice: 80 g protein

Limiting amino acid

Protein Content

Egg

White Rice

Pinto Beans

Soy Beans

Amount

1

1 cup

1 cup

1 cup

Protein

(g)

5.5

4.4

15

33

Kcal

65

242

245

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 · 2014-06-16 · the recommended dietary...

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