Sunday, May 18, 2014

Fivefold More Than the FDA Allows: Extreme High Protein Diet (4.4g/kg | 307g/day) Benign & Non-Obesogenic. Plus: Macronutrient Prescription & Changes in Food Quality

Monster milk was not the product that was used in the study at hand, but an undisclosed, but certainly non-negligibly large quantity of the more than 300g of protein came from whey and casein shakes and will thus have had a major impact on food quality.
Jose Antonio has finally conducted a study you can show your grandmother who wasn't just taught that fresh bread would give you the gripes and too much protein would clog your liver and overwhelm your kidney. Now, the average US dietitian certainly loves his grandma. It's thus not surprising that the ~1g of protein per kg body weight his average customer consumes on a daily basis is almost too much in his gullible eyes.

Now, I don't know whether it's true what some people in Germany say, i.e. that gripes and clogged kidneys were invented in days, when both bread, and even more so meat were rare to have a better reason than "there is not enough food" to tell your children, when they were about to "overeat" on either of the two is obviously, but in the end, I would not wonder if the underlying reason for a USDA intake recommendation was - as it is with the "good" cereals and grains - an economic one.
You can learn more about protein intake at the SuppVersity

Are You Protein Wheysting?

Cod protein for recovery

Protein requ. of athletes

High EAA protein for fat loss

Fast vs. slow protein

Too much ado about protein?
Enough of the ranting, though, if you take a closer look at the study itself you will see that the design was kept as simple as possible. Antonio et al. grabbed a bunch of suicidal (who else would dare eating >5x more protein than the holy RDA allows? ;-), but otherwise healthy resistance-trained men and women who had been resistance training regularly for the last 8.9 ± 6.7 years and an average of
8.5 ± 3.3 hours per week who were unequally randomized to a control (CON n = 10) or high protein diet (HP n = 20) group.
"The purpose of unequal randomization was to take into account the loss of subjects from potential lack of compliance due to the high protein diet as well as gaining additional information on the treatment itself." (Antonio. 2014)
While the individuals in the control group were advised to maintain the same dietary and training habits over the course of the study. The subjects in the high protein diet group had a clear order that read: "Consume 4.4 grams of protein equal to 4.4 g/kg/d." (Antonio. 2014)

307g of ptorein per day at only 2835kcal? No problem if you have protein shakes

For the average study participant trying to live up to this demand yielded an average protein intake of ~307g protein per day. Needless to say that the latter induced a significant shift in the macronutrient composition, as well as an unfortunately undocumented shift in food quality (I will write more about this in the bottom line).
Figure 1: Macronutrient composition (g) during the 8 week experiment and changes in energy intake (pre vs. post)
The practical realization of this one request turned the "SAD-ish" (=standard American Diet like) menues of the average study participant into a high protein diet, with a macro-composition that comes astonishingly close to what I have described in my interview series with my buddy Sean Casey (read the interview @  29.6 ± 8% | 45.5 ±  9.9 % | 27.0 ± 6 % from carbohydrates | protein | fats.
With only 226g of carbohydrates the previously mentioned dietitians would call this "a dangerous high protein low carb diet that ignores the fundamental need of the food industry to sell tons of healthy grains"... obviously they would not say the stuff after the "that...", but I think you are getting the idea here. What we are dealing with is in fact a high protein, albeit rather lowish carb diet, that delivers the baseline amount of carbohydrates I have suggested in "Carbohydrate Shortage In Paleo Land" (read the whole article) along with a little extra that keeps their energy levels stable, in spite of regular workouts and prevents the dreaded liver glycogen depletion on real low carbohydrate, but due to very high protein intakes non-ketogenic diets that's carrying off one mislead trainee after the other, these days.
With only ~200g of carbs you can very well manage your regular training load: While there were differences in training volume with a 21% higher volume in the control = high carbohydrate group, the difference reflects the difference in training volume before the study and has nothing to do with the dreaded lack of performance people on really low carbohydrate extreme high protein diets experience - often without being willing to admit that they are "eating themselves into the ground".
If you look at the study outcomes in Table 1, there are - aside from the previously hinted at non-fatal nature of the diet - a couple of other interesting things to observe - most importantly: No changes in body composition!
Table 1: Changes in body composition pre vs. post 8 week high protein vs. placebo intervention, absolute values,
(BW: body weight, FFM: fat free mass, FM: fat mass, %BF body fat %; Antonio 2014)

Now, in view of the way protein is glori- and carbs villified these days in the fitness industry, some of you may find that surprising or disappointing. I for my part would rather say that it confirms what you all should know: More protein does not build more muscle (learn more)! That's not "bad". That's basic physiology that is rooted in the same processes as the non-existent weight gain, Antonio et al. rightly consider to be the "key finding in the present study." (Antonio. 2014) - yes, as surprising as it may seem, the study at hand really is, the
"first investigation in resistance-trained individuals to demonstrate that consuming a high protein hypercaloric diet does not result in a gain in fat mass." (Antonio. 2014)
We have tons of studies on the effects of high protein diets in low-energy intake (hypocaloric) scenarios, but overeating on protein is news.

With the Bray study (read more) we had a completely different scenario. The corresponding experiment in the course of which the subjects gained a significant amount of body fat on a "high protein" (Bray's interpretation) diet, we do still have a candidate that can help us explain the lack of body fat gain in the study at hand. In said study, the fat gain in the high protein group was after all slow compared to the one that occurred in the subjects who were overeating (+40%, by the way ) on fat, and carbohydrate. It's the "effort" (kcal = energy loss) that's connected to the use of protein as a source of gluconeogensis and the additional energetic effort that's required to turn this newly formed glucose into fat and store it that explains a large part of the observations in both, the Bray study and the study at hand (Antonio. 2014).
We are what we eat! Acknowledged, but does this also go for your hormones and different in protein intakes? Let's have another look at the contemporarily available research to figure that out | read more
Bottom line: In as much as I believe and in fact even recommend to eat a high(er) protein diet with a controlled amount of carbohydrates in them for weight management (losing and maintaining), I still have to point out that the study lacks the power to assess the effects of changes in food quality. Even with an extra energy intake of 793kcal/day it's not possible to simply eat more of the same junk you'd have to eat to end up at 198g of carbohydrates, 162g of protein and 179g of fats per day (PRE diet).

We do thus have to expect that the null-effect - and this does not change the value of either the study or high protein intakes - was thus at least in part a result of changes in food intake of which the paper informs us that they consisted of ommercially available whey and casein protein powder  (MusclePharm® and Adept Nutrition [Europa®]). Is that a problem? No, but you've to keep the side-effects of macronutrient modifications in mind.
  • Antonio, Jose, et al. "The effects of consuming a high protein diet (4.4 g/kg/d) on body composition in resistance-trained individuals." Journal of the International Society of Sports Nutrition 11.1 (2014): 19.
  • Bray, George A., et al. "Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating: a randomized controlled trial." JAMA 307.1 (2012): 47-55.