Different Patients, Different Protein Needs
Today we’re joined by Kira Sutherland, a Naturopath with over 25 years of clinical experience who offers specialised support for athletes and today; we’ll be discussing…The different protein needs of different patient groups.
In this episode, we discuss RDA’s of protein, absorption issues, protein requirements across the ages, conditions affecting protein requirements and more.
About Kira Sutherland:
Kira Sutherland is an Australian Naturopath and Sports Nutritionist with more than 25 years in clinical practice.
She is the 2019 winner of the Integrative Medicine Award for Excellence in practice (Nutrition/Dietetics). Kira divides her time between clients, lecturing at the undergraduate level, and mentoring practitioners of complementary medicine in the application of wholistic sports nutrition.
Known for her vibrant, straightforward teaching style, Kira’s focus is to empower and educate at a level where information becomes intrinsic knowledge. She is a lifelong athlete herself, participating in endurance sports, providing her with a solid foundation of practical experience to add to her academic and clinical background.
Connect with Kira
LinkedIn: Kira Sutherland
Andrew: This is “Wellness by Designs”, and I’m your host, Andrew Whitfield-Cook. Today, we’re joined by Kira Sutherland, a naturopath specialising in offering support for athletes and women with hormonal imbalances. But today, we’re talking about something a little bit different. We’re going to be discussing different protein needs for different patient groups. So welcome to “Wellness by Designs,” Kira. How are you going?
Kira: Oh, good, I’m good. Thank you for having me. Always good to…always good to see you.
Andrew: Always good to chat. Now, you and I tend to muck around a bit, but we’ll try and be serious anyway. Anybody who wants to learn more, look at the reel that we did at NatEx2021. But anyway, firstly, for those rare souls who may not know you, can you take us through a little bit of your history, please?
Kira: Yeah, sure. So, I’m a naturopath, a nutritionist, and then I went on, and I did post-grad qualifications in sports nutrition. So I kind of sit between what we know in our world of naturopathy, holistic nutrition, and then working with not just athletes but women, teenagers, all different groups, you know, oh my gosh, doing sport, getting fit, weight loss. So it’s just kind of a niche I’ve ended up in.
What else do you need to know about me? I lecture at university. What else? I have a very heavy sporting background, not heavy; I’m not… Sports deep background. I was that kid that played every sport possible. And as an adult got heavily into endurance sport like Ironman and triathlon, and marathon running and things like that. And to this day, I continue to do a lot of sports. So it’s kind of I live what I work, and I work what I live.
Andrew: Yeah. You believe you certainly do. Can I ask you, did you have a favourite sport when you were younger? Or was it always running?
Kira: Ooh, no running…kind of, I’ve always loved running. But growing up, I was a swimmer, a basketball player, a skier, and a soccer. Those were kind of my big ones. As an adult, I really got, you know, into the triathlon and the running more. I’m not… Let me just also locate it; I’m not a fast runner. I just love running.
Andrew: Right. That’s all right. You’re still very, very fit, certainly.
Kira: I try.
Andrew: So, firstly, let’s dive into the topic at hand, and that’s protein. When we’re dealing with protein and macronutrients, we’ve also got to think about RDAs, or recommended daily intakes. So, one of the recommended daily intakes of protein, and I guess that’s going to vary for different age groups for males to females. So, can you take us through a little bit of this quagmire, please?
Kira: Yeah. It is a bit of a mess. I mean, the science behind it is great, but some of it is old, and some of it is being redone. But in general, the RDA for men and women for adults is, depending on which country you’re in, it’s 0.75 or 0.8 grams times your body weight in kilos is the amount you need per day, really to stay out of protein deficiency. That is nowhere near what most practitioners would consider to be an optimum level. That’s just the RDA of what you should be having. When women are pregnant, the RDA goes up a little bit. With children, it can go up. For teenagers, it can go up again during growth spurts. But in general, 0.8 is what you most often see.
Andrew: And what are these RDAs based on? Like, I remember rumours, and I don’t know how real they are because I actually remember once trying to investigate these and never really got anywhere. Somebody once said, forgive that vernacular. Somebody once said that the RDAs of various vitamins were based on keeping you from deficiency, and they were based on prisoners from Changi from World War II. Now, I think they’re probably updated since then. But with regards to protein adequacy, what are they based on?
Kira: I’m gonna be honest, I don’t… I turned that off. I promise I turned that off. I don’t know. I actually have no idea where they’re basing them on anymore. I feel like the last time I looked at something like that, it was from about the 1970s or the 1980s. But I don’t also want to get in trouble with researchers who have come out with more recent things. But I definitely know they have not changed in the last 20 years of my clinical practice. But it’s probably from some retrospective nurses study, you know, that big health nurses study or something. I don’t, actually…I love my micronutrients, but I’m unaware of the history of that; we’ll have to look it up after we finish.
Andrew: That’s all right. But let’s talk about, you mentioned, you know, what an RDA is, let’s talk about optimal, then, protein. What are we talking about here? What’s the difference? That’s going to vary for different groups, but…
Kira: It’s totally going to vary, and it’s gonna vary, you know, between are you growing still? Are you in those teen years? Are you pregnant or lactating? We now have more research coming out for when people hit; I’m going to use the term that I like in sport, the masters’ age bracket, which is usually 50 and over. I don’t really think 50 could be considered elderly by any means because otherwise, we’re both there.
But yeah, there’s…as we age, we now are looking at protein needs by the decade, and how those are actually increasing for health and longevity. So, optimum, you know, a lot of the governing bodies don’t want to actually state what is optimum because there are too many variables. Whereas I’m more aware of the optimal for different sports more than the general population. So, when we’re looking at sport, we tend to see ranges of…or people that are physically active. And in reality, we should all be physically active three, five times a week. So, this should be everybody. The general recommendations are between 1.2 and 1.6 grams per kilogram of body weight, and then there are times where they actually take those amounts all the way up to 2.2.
Andrew: Okay, but again, that’s gonna vary. Like, there’s a few conditions going through my mind here. One of them is weight loss. But when you’ve got weight loss, you would think, “Ah, so you need less.” Well, hang on, you’ve still gotta run detox because if you’re going to be mobilizing fat, you’re going to be mobilizing fat deposited toxins. That requires protein to run adequate biotransformation in your liver. So, help us through this. Let’s go through some conditions which might require higher than normal protein requirements.
Kira: Well, and it’s interesting; I was reading the other day in prep for us having a chat. I was reading about how the liver actually steals the majority of the amino acids that we ingest, and it’s only up to about 30% of the amino acids we actually ingest that gets used for things like muscle protein synthesis and other things because the liver sequesters so much of the amino acids for other processes.
Andrew: Wow. Thirty percent.
Kira: I didn’t realize that… That’s about all it leaves it. Although that’s not all the amino acids. When we look at the branched-chain amino acids like leucine, isoleucine, and valine, which we consider so important for muscle building, the liver doesn’t want those for much else. I got to be careful how I say that. The liver isn’t that interested in those versus some of the other amino acids, so those get through more easily for muscle building.
Andrew: Okay. But let’s look at some of the other amino acids, glutamine, for instance, glycine, running glycination. So glutamine with glutathionylation. Glycine for glutathionylation as well. But you’ve then got other processes, acetylation, methylation we were going to talk about separately, I guess. But, you know, gluten demands from the body, particularly at the gut level, particularly talking about with relation to neurotransmitters like GABA. But also, if you’ve got damage to muscles in the body, glutamine, for instance, is one of the biggest things that they’re given in parenteral nutrition for, say, motor vehicle accidents, you know, ICU. Take us through some of these.
Kira: I think 60% of our glutamine pool actually resides within our muscles. Yeah. That’s how important glutamine is in that muscular structure. Yet immune system is so dependent on it when it’s in crisis. You’ve got, you know…the immune system uses a lot of glutamine as well, right?
Andrew: Yeah. Of course.
Kira: And digestive…you know, we all think of it as digestive system and neurotransmitters and things like that. But, you know, glutamine is so heavily used. And in sport, when people are having immune system problems, it’s one of the first things we look at, supplementing higher dose glutamine to try to kind of counterbalance what’s being stolen by the muscles for the immune system.
Andrew: Yeah. And when we’re looking at glutamine dosage, like, you know, some people got 200 milligrams, you’ve got to talk about tens of grams to have an adequate thing. I remember this paranoia, and it annoyed the hell out of me, this paper, but it was talking about glutamine feeding cancer cells. That’s at the cellular level. Yeah, I’ve covered this with Lisa Altshuler.
When we’re talking about intake, ingestion of glutamine into the gut… Yeah, when we’re talking about ingestion of glutamine, it’s got nothing to do with what’s happening to glutamine at the cellular, and particularly the cancerous cellular level. It’s far removed from that. So, take us…can you take us through some relevant dosages that you’ve used in, like, for instance, athletes who have gone through, you know, let’s say strength training, so they’re going for overload, not demand. They’ve got, therefore, muscle damage, you know, myofibril damage. Take us through what are the relevant dosages with glutamine, and indeed, some of the branched-chain amino acids, things like that.
Kira: Yeah, so, it’s…I mean, it’s also different because, with athletes, you’re always focused on their overall protein intake. So I’m not… I’m always going to make sure they’re hitting those protein targets first, and then if we decide they need more glutamine, I’m looking…I’m a little bit nervous; I will start a bit low, just because some people will overreact to glutamine dosage, you know, glutamine as a supplement. So I often start…literally, I start at 2 grams for a couple days, and then I build to 5 grams. Five grams of glutamine is really…that’s like a common maintenance dose that I would use for someone having kind of immune system issues at the same time that they’re heavily training. And I will take people up to 7 to 10. But I tend to…I’m a little bit cautious, so five tends to be my favourite number—I kind of stick with it. But I will recommend it. I’m not a [crosstalk 00:12:31] syrup.
Andrew: Gotcha, okay.
Kira: But that’s glutamine. When we’re talking branched-chain amino acids, that’s a different story, you know, you’re often giving 10, 15 grams, 20 grams at a pop. But, again, I don’t use branched chains that often by themselves; I tend to use whole proteins. Where most of the research is in sports nutrition is actually using foods as protein and then isolate. So, whey protein isolate, you’re using your collagens, but that’s a bit different. Depending on what plant-based proteins, and so, I tend to stick more with the foods and food-based powders because that’s where the research is in sport.
Andrew: Gotcha. Okay. So, let’s delve into that a little bit. When we’re talking about protein sources of food, you know, the things that just immediately pop into the mind are, you know, meat, chicken, fish. But then you’ve got certain sub-populations; you’ve got vegetarians and vegans. How do you cater for this population when they’re in…they have a requirement for a far greater protein requirement?
Kira: Yeah, well, we have problems with that sometimes. So, you didn’t mention eggs, so, if I have a vegetarian that’s still willing to eat eggs, I’ll be honest, I literally will; as a clinician, I will beg people to keep eggs diet just because it ranks so high on biological value of protein, it’s just such an easy source for people as long as they’re not allergic or sensitive to it. And then you have to go down, you know, can the person handle any dairy? Can they do whey? If there’s not a dairy issue, your whey and your…even casein is used in sports nutrition, although I tend to stay to whey.
And then, if we’re losing all that and you have a plant-based client, you’re pretty dependent on plant-based protein powders. I have yet to see somebody who can actually do it plant-based all through food as an athlete because, remember, I’m also working with people with larger volume calorie needs. They’re starting at 2,000, and we’re working our way up to 4,500 calories a day, potentially needing it. And it’s just; they can’t… If someone needs 100 grams of protein a day, there’s only so much tofu and beans that you can get down in a day.
Andrew: Yeah, despite how much we try.
Andrew: Might do chicken and lentils. But can we just discuss that one? Like, I remember the old days, you know, with the bodybuilding powders. And they started off with milk protein, which was rubbish. Then, of course, we had the whey protein; we had the whey protein on its own, quite high carb. Then we go the whey protein concentrate, more high protein, very important immune factors in there, which I liked. But then you’ve got the whey protein isolate. Then you’ve got the ionized whey protein isolates. There’s so many on the market.
What I thought was hilarious is where I used to work from; I would keep one one tin of egg protein concentrate. And before it went out of date, one person would come in and buy it, more like an Arnold Schwarzenegger sort of person. And out he would go, and I would just replace it with one tin of egg protein because it tasted like rubbish. Can you take us through the different types of these proteins? What their benefits are? Where they sit? What are your choices? I haven’t even covered hemp, pea protein, rice.
Kira: Yeah, yeah. And do you remember when rice protein powder first came out, and it was really like a carb protein powder? It wasn’t really…I remember when one of the companies first came out with it, and I’m like, “That’s not a protein powder, that’s like a…” It was like a refuelling mix, right? You were going to get 30 grams of carb with every 20 grams of protein that you were ingesting. So, oh my gosh, what’s happening with protein powders today?
So, you know, you do have to be really careful with this as well, when you are in smoothie stores and places offering to make you smoothies with extra protein powder. My understanding, actually, the rules are, they could actually just be putting milk powder into your smoothie, and they’re allowed to charge the extra $2 for that protein hit. So, definitely, if you or your clients are out trying to get a proper recovery smoothie, make sure you’re actually asking what the protein powder is that’s being put in because you’re paying like $2 or $3 for what costs 10 cents to put in, you know, milk powder.
So, we now really basically use isolates. That’s pretty much what’s happening with the wheys. We don’t tend to use much more these days because it’s been through its enzymatic bath; it’s been through all of its processes. So we’ve got literally just that pure protein, which we are finding has great signalling for muscle protein synthesis. What more do we want to know about this? What was the question again?
Andrew: Well, there are so many proteins. You and I, Kira, I tell you. There are so many proteins. I mean, even if we concentrate on the dairy proteins, right? The whey protein concentrate, isolate, ionized, just those three, there can be vastly different protein levels. But then we’ve got the whey protein concentrate, less protein, but it has the immune fractions in it.
Kira: Yes, it does have immune fractions. And again, it’s also dependent on, you know, I’ll be honest, I will use both. A lot of times, when you’re buying products, it contains both, and it really comes down to what’s working for the client, you know. And some people aren’t going to react… Whey protein is actually quite low in lactose; it should be down to less than 3% lactose. So some people that are lactose intolerant can actually handle whey protein, especially the isolates rather than the concentrates. If you just think about it,
rather than going biochemically, the concentrate is closer to regular dairy, and then the isolate is it’s just been through further processes. And then, the new form of isolate has been even further through processes to hopefully allow you to access the amino acids more efficiently.
As I said, I pretty much sit between people using dairy, if they can handle it, or using an isolate; that tends to be where I am. And again, it’s looking at what else has been added to it, what flavourings they’re using, you know, what chemical…? Because some of those protein powders are a bit of a shitstorm of, you know, artificial sweeteners, and what’s going in there. So I’m as busy looking at that. But I’m often… Yeah. Hmm, I don’t really have a whole lot to describe between them. Yeah.
Andrew: But it’s an important point you make about that lactose dose in each thing. Do you find that the whey protein isolates don’t react as much? Admittedly that it’s dairy, so they’ve got to be, you know, on the whole dairy tolerant. But do you find less gut symptoms in those people that might have a little bit of lactose intolerance when they’re taking the isolate?
Kira: Yes, absolutely. So I find they are a lot more tolerated by people, even more so than the concentrates. Do I have clinical proof? I mean, do I have research proof for that? No. I have clinical, you know, just what people tell me works for them or not. And again, the minute someone’s having dairy trouble or whey trouble, I’m then these days move people to collagen as long as they’re not plant-based. I love using the collagen protein powders that…because they have so many other great benefits.
Pound for pound, well, I’m American there saying that, but pound for pound, in clinical research, whey protein will outperform any other protein powder on the market for enhancing muscle growth. In all the research that’s been done, whey still outperforms, it outperforms soy, it outperforms collagen, it outperforms everybody, not by a lot, but if you were looking for that last tiny little bit, whey still gets the gold medal versus like collagen. I would put collagen and so many other great things. And it’s tolerated so well. I have yet to have a client be allergic to a collagen supplement I’ve given them, thankfully—that silver medal.
But soy comes out, it’s super controversial, but for muscle protein synthesis, soy comes out quite well. And then pea and hemp kind of just come in under that. But you have…you know, these days you’re really dealing with plant-based or omnivore for what you’re dealing with with protein powders, I find.
Andrew: Yeah. So, when we talk about these ratings, we’re talking about the biological value, and there was a pea protein efficiency ratio, is that right?
Andrew: And there was a lot of controversy as to which one was the best measure, BV or PER. My memory back in the old days was that egg was the best, but nobody liked it. So, it was like, forget it. There was just that one person who would get it. But whey was always the winner, always. So, let’s go through a few of these conditions, though, where protein requirements increase dramatically. Now, we’ve gone through, you know, muscle building, which is ripping when we think about ripping of a myofibril and regrowing that. But then you’ve got things like trauma, like damage, crush injuries, burns. I mean, there’s so much to go on with. What about other conditions? What sort of…what can we cover here, where protein is a real need to look at?
Kira: So, I think the really under…it’s not a condition, although I’m sure parents would call it a condition, but let’s talk about teenagers. Is that a condition?
Andrew: It’s a psychiatric condition for the parents.
Kira: I know. And I own a teenager… I have a teenager, I should say, I don’t own her. Yeah, so teens have a massive increase in protein needs. And this is also hitting at the…there’s all that growth, there’s the hormones spiking, all kinds of stuff, and at the same time, they’re junk food junkies and wanting lots of sugar and carbs and sometimes it’s really hard to move them towards those protein foods. But their intake massively goes up. And then, depending on how sporty they are, it goes up even higher. So, you know, teenage needs kind of go from about 1.4 to 1.8. And a lot of people don’t realize that. Those 16-year-old boys that come in that are, you know, desperate to put on muscle because their body has basically grown up before it’s grown out. They need to be…I mean, you have to convince them to be doing the actual weights as well. But they need to be up at 1.8 most of the time, and a lot of people just don’t hit anywhere near there.
Andrew: Just a side thought, and forgive me for going off on my little mind tangent. But when you were talking about teenagers and when you were talking about their massive carb intake, it sparked a memory in my brain about when ankylosing spondylitis very often presents, and there was the work by Professor Alan Ebringer. And forgive this analogy, but he’s got this KickAS, KickAS.org website where he talks about how he basically retrains teenagers to eat differently instead of their very high carb. And he swaps it. Now, obviously, he’s dealing with a disorder that requires intensive therapy, including antibiotics, because there’s an immune reactivity going on.
But regarding the dietary intake, would a musculoskeletal disorder like ankylosing spondylitis, like Scheuermann’s disease, scoliosis, is that somewhere where you might consider adding more collagen into?
Kira: Ooh, that is a really good question. But I’m gonna have to admit; I don’t have great depth in working with that. I would think… I mean, to me, it makes sense. Because, again… Well, yeah, I have to say that’s out of my realm of what I deal with a lot. So I don’t want to be leading someone down the pathway of the wrong information. But for me, yes, I would be looking especially at really efficient forms of protein such as collagen because you are getting all those other benefits with collagen.
Andrew: Gotcha. Okay. Andrew’s mind coming back from a tangent. That’s
Kira: It’s a great tangent, but I know nothing about that. I’m gonna stay in my lane, and yeah.
Andrew: Got it. So, let’s concentrate on weight loss, then. Now, you know, again, we said earlier, when you’re losing weight, hopefully, we’re not losing muscle. So let’s start from there.
Kira: Yeah. So, a lot of the latest research on weight loss has protein intake going up quite high, much higher than what we used to do. I remember people often talking about, oh, take it from the RDA up to about 1.2, 1.4. Whereas most, or a lot of, I should say, research for weight loss is looking at 1.5, 1.6, 1.8, I’ve even seen up to 2.2 grams per kilogram of body weight, depending on what’s going on for the person. And again, it also depends on where they’ve come from with their diet and what are you changing.
Some of the other recent research is actually looking at if we start dividing down between men and women, and that’s the big thing we need to look at, especially in protein research is we often… A lot of our protein research that I’m up on is done on male athletes, and that hasn’t included a lot of women. And we’re starting to now look at women actually may need slightly less than men. And I don’t know, in the weight loss research area, if this has also been looked at. But women often, we just keep a little bit lower than men these days when we’re looking at protein needs in sport. And I kind of play with weight loss as well. So I’m not always going to jam my female onto the highest amount; I’ll kind of go with the 1.6, 1.7.
Because if you look at… Here’s my tangent. If you look at somebody’s body type, you know, we have all these amounts, and this is what you should be doing, but we’re all built so differently. How tall are you? Are you mesomorph, endomorph, ectomorph? And, hypothetically, we’re starting to look at, depending on your body type, you may have different protein needs as well. And sometimes, those amounts vary greatly between body types.
Andrew: Right. I mean, that’s so interesting, because I remember, in the olden days here, you remember the three body types. And we used to basically use
different ratios of protein to carb to fat depending on the body type. That’s it. Now, we’ve come a long way since then. But just to keep going on a point you made, when you’re talking about weight loss, how does increasing a protein intake fit in with the very-low-carb diets, the VLCDs? How does this all fit in when we…? Ketogenic diets, for instance.
Kira: Yeah. Well, you’ve also got two types of ketogenic diets, you’ve got a high-protein ketogenic diet, which was really…that was the original Atkins, and that was, you know, a couple decades ago, whereas, these days, when we go ketogenic diet, that’s actually high-fat, regular protein volume, and very-low-carb. So, in the ketogenic diet that most people are doing these days, you’re not going higher than 20% protein because if you go too much higher than that, you actually will throw yourself out of ketosis. After all, it’s really all about those fat ratios being at, you know, 65% to 75% as a maximum, and you’re keeping the carbs at that, you know, probably at 5%, 10% at the max. And so, all you’ve got left is about 20 for the protein. So, that’s what’s happening with the ketogenic diets. What was the other question?
Andrew: With regards to the VLCD, the very-low-carb diets.
Kira: Yeah. Well again, you then have other weight-loss diets where they’re going that very-low-carb, but they’re looking at, you know, 30%, 40% protein. And, again, about that same amount or a little bit more of fat. So, there are people doing the low-carb but not actually ketogenic. And so, the protein and the fat are sitting a little closer together, but I don’t find that is as popular. I find either people want to be going for that ketosis, or, yeah, they’re doing other means of… Yeah.
Andrew: Gotcha. And when we… I’ve got to stress here, just so that people get the right idea. When we’re talking about ketosis, we’re talking about mild ketosis that you must measure so that you know you’re in mild ketosis, not think you’re in mild ketosis and end up going way off the Richter scale. So, ketogenic diets must be measured with a keto stick.
Kira: Absolutely. I cannot tell you how many people come into the clinic, and they’re like, “Oh, yeah, I’m doing ketosis, but I haven’t lost any weight.” And you’re like, “It’s pretty hard to do ketosis and not lose weight.” And then you end up going through their diet, and they’re not measuring their ketones. And we’re talking nutritional ketosis, not like diabetic ketoacidosis. And they’re nowhere near ketosis. They think they’re doing it, and they’re just eating more fat but not eating low enough in carbohydrates. And I’m not even a fan of using urine dipsticks for ketosis. Because those tell you nothing, you know, the little urine sticks basically tell you… If I’m going to put someone in ketosis, I really want to know what’s going on.
So, those urine sticks are like you have no ketones, your ketones are at 0.5, and then the next rank is 1.5. And when you want to get into nutritional ketosis, most of the time, you’re going to sit between 0.5 and 1.5. But you’re going to have a massive difference of outcome if you’re sitting up at 1.5 than if you’re just sitting down at 0.5, which I can probably get myself into by fasted training in the morning after eating an early dinner. So, I’m a big fan; there are apparatuses that you can blow into to measure ketones, I haven’t used those, but they are really popular. I tend to use blood monitors. So, like a blood glucose monitor, you can buy specific ones that also measure ketones, and it’s not cheap, it’s like $1 every time you want to measure them, but those are the ones that really show you how you’re going in your ketosis.
And you can really play around with it with like…some people; dairy food works really well in ketogenic diets, other people are too sensitive to the lactose and having dairy food throws them straight out of ketosis. So it’s also really watching those fine details of, you know, what’s working for someone in their diet.
Andrew: If somebody was doing a ketogenic diet, when they’re up in that 2.2 grams per kilogram range, is that still enough of a ratio to be able to have adequate fat to stay in ketosis? Or are we really, you know, pushing the protein up so high that we might be influencing? What is it? IGF, Insulin-like Growth Factor-1.
Kira: I have never put anyone into a high-protein ketosis diet; I’ve only ever used high-fat ketosis diet. So, I’m unaware of that downflow of what’s actually happening. Because it’s just, nobody wants to go into high-protein diets. When people are on…when I have people doing 2.2 grams per kilo body weight of protein intake, those are usually people that I, you know, 2.2 is high. Some people are doing that in weight loss, but they’re not actually hitting, or they’re not trying to hit ketosis. I think going back two questions ago, what’s the benefit of going high-protein? Why do we take protein? But let’s get to probably what you asked, why do we take protein levels up so much during weight loss?
When we’re losing weight, when we are in calorie deficit, because lets be honest, if you’re not in calorie deficit, you won’t lose weight. Calories in, calories out is this big fight, and I’m not going to swear. But, oh my God, you have to be in calorie deficit to lose weight. Like, it’s math.
Andrew: It’s called physics.
Kira: Yeah. There are reasons you can be in calorie deficit and not be losing weight because of inflammation and other issues, but that’s not today’s talk. When you lose weight, you will lose muscle mass; there is no way that you don’t also… You can’t just say to the body, “Oh, please just use my muffin tops and not my hamstrings.” You will lose overall body tissue when you lose weight. So, one of the reasons we take the protein up is hopefully we have some muscle-sparing because we’re fueling the body with enough protein that it will hopefully stay in that remodelling phase and, you know, hold on to more muscle mass, so we’re not losing so much. Because, again, as you lose weight, and you lose body size, you lose metabolic rate, you know, people forget that the more mass you have, the more calories you need per day to stay that mass. So, as people lose weight, we actually have to readjust their calorie intake because they’re a smaller person; they don’t need as many calories. And we forget that.
The other thing about taking protein off is protein has a higher TEF. So if you don’t remember that from first-year nutrition, that’s your thermic effect of food. So protein is harder to digest, it’s slower to digest, we need lots of enzymes. You hopefully know lots about that. But it actually takes more calories to digest a gram of protein than it does to digest a gram of carbohydrate. So you actually have… Yeah, it’s more metabolically expensive to digest protein. And that’s where some of the weight loss also comes from. Like if you take twins and you put them on 1500 calories a day, but one is on a high-carb diet, and one is on a high-protein diet, the twin on the high-protein diet will lose more weight because she’s using more calories to actually burn her fuel. Did that make sense?
Andrew: No, it does. There’s 20 questions that come off of that.
Andrew: So, the first one, when we’re talking about it being more expensive, if you like, for our body to…more caloric expensive to digest a gram of protein, do you then, if you’re trying to maintain muscle mass in somebody who’s losing fat, do you utilize perhaps a proteolytic or digestive enzymes, therefore, to just make sure that that protein is going to be digested as much as possible? Betaine supplements, apple cider vinegar, the whole gamut of what…do you use those?
Kira: Absolutely. You’ve got… Yeah, absolutely. Whether you use digestive enzymes, like you actually take proteolytic enzymes, or you use the foods, like, you know, your bromelain-rich foods. You’ve got your pineapple, we’ve got kiwi, we’ve got papaya and papain. There’s a lot of natural foods. My understanding is even eating fermented foods helps with that process as well. But I will use HCL, digestive enzymes, all kinds of stuff in the hope that you’re digesting it properly. And again, we know via research, it’s not about eating huge clumps of protein at once; it’s about splitting it apart, hopefully, between at least four times during the day. There is a lot of research about protein utilization and when we need to space it out during the day.
Andrew: Right, okay. We could go off again there. But what about timing about late at night versus earlier meals? I mean, you’ve got a whole issue of reflux, I get it, but what about the latest time you should eat protein during a day?
Kira: Ooh, well, that’s actually a little bit…I don’t want to be controversial here. I mean, if we’re talking about weight loss per se, we are looking at finishing a meal two to three hours before going to bed, or we’re looking at hopefully starting a fasting window earlier rather than later in the evening. And that’s something, you know…intermittent fasting, whether you do it or not, I’m actually a bigger fan of people finishing eating earlier in the evening rather than not eating in the morning, because there’s a lot of metabolic…you have a lot of metabolic power first thing in the morning. Your insulin functions better, your digestive system actually functions better, and so, I’m a fan of finishing the meal earlier in the evening rather than eating later; I hope that made sense.
Andrew: Yeah, it does. I just realized what I’m doing wrong, that’s all.
Kira: Well, we love. We love sitting down, log in to Netflix, eating a big meal. A majority of people do 50% of their protein intake with their dinner, whereas you really actually need to be spreading it out during the day. The way I work with clients, whether they’re athletes or weight loss clients, it doesn’t matter, I say to them, every time you go to eat, you must locate your protein source first, and then build your meal around that idea. So, have you just been training? Okay, you’re going to need more carbohydrate in that meal as well or more starchy complex carbohydrates. Have you not been exercising? If you haven’t, then we’re gonna go easier on those starchy carbs and harder on the vegetables and things like that.
So, you know, that’s the number one thing we should be focusing on at each meal is where is that protein coming from? You also don’t…we know from research on athletes, we don’t want to be grazing on protein every two hours either, especially if we’re looking at trying to maintain muscle mass, because we now know, through signaling pathways, that when we eat protein, leucine, which is…it’s one of your three branched chain amino acids, but it’s your premier, or it’s your leader as far as muscle protein synthesis goes, as an amino acid. When you eat protein, your leucine threshold you want spiked, it goes up to a certain level in your bloodstream, and that helps to signal mTOR and the creation of muscle. But then we actually need leucine to drop off in the blood. We need the levels of leucine to actually come down below a certain level before we do another hit of protein to spike leucine to signal, you know, MPS happening again.
And so we’ve realized this constant grazing every two hours on protein doesn’t build us the best muscle, you’re much better off doing four, five, you know, hits during the day, but at least three hours, you know, even better, four, between big hits of protein.
Andrew: That’s a great lesson, actually, because we’re also talking there about, you mentioned the mTOR pathway, we’re talking about insulin resistance there. And we’re also talking about cancer drivers. Or, let’s say, the unbreaking of a cancer break. So, it a very important lesson, not just for muscle mass, but also for long-term health. Yeah. And, Kira, there’s so much we could go into here, but we have to touch on these. So, we haven’t touched on life stages, like menopause, for instance, and we haven’t touched on malabsorption, celiac disease, inflammatory bowel disease, and the like. Can we go through those before we go…we’ve already run out of time, please? You and I…we’re gonna have to get you back for another one, I know. Another podcast.
Kira: So, let me jump onto menopause, but let me also jump onto both men and women. All the latest research is actually showing that our muscle…not our muscle needs, our protein needs actually go up as we age. So as we hit those last three decades, I’m not going to quote, you know, as we hit 50, 60, 70, and above, our needs for protein actually go up; it’s harder for us to maintain muscle mass. But maintaining muscle mass is actually one of the best indicators of longevity that we now have. And it’s harder to make muscle as we age. And so, this is why they actually think the needs go up as we age. So once people go into their 50s and 60s, we are looking, again, at that 1.5, 1.6, potentially, as a steadier amount, or maybe 1.4 to 1.6 as a need.
And again, women always have slightly lower than men. And also, just to point out, the less fit somebody is, often their protein needs can be a little bit higher. Whereas very fit people or athletes, after they’ve already reached a certain fitness level, they can actually drop their protein amounts ever so slightly because they’re not in that muscle-building phase. And some of the latest research with women actually has women at slightly lower amounts than men. So when you see generalized guidelines, especially like an athletes in protein, know that those…they are for both men and women, but in reality, probably 75% of the research that they’re quoting has been…or extrapolating from has been done on men. So sometimes women just need that little bit less. But I’m talking the difference between 1.8 and 1.6.
Andrew: Yeah, yeah. So, malabsorption. We’ve got anything from celiac disease, IBS, dumping syndrome for people who are way over it, but you’ve also got inflammatory bowel disease as well. So, can we talk a little bit about their protein needs, how you manage this? And indeed, how you might manage issues like putrefaction in the gut, for instance, with constipatory IBS?
Kira: Yeah. So, you know, when we’re looking at a lot of issues like that, and protein needs going up, how much is being absorbed versus how much do you need? It’s a little bit of a tricky situation because often in inflammatory bowel disease, they’re going to have a lot more trouble absorbing their protein and utilizing it, yet, if you think about the gut itself, the gut itself and a lot of our immune system is heavily reliant on good protein levels. And so, you’ve got this kind of, what’s the term I’m looking at? Like a catch-22, where you need one to help the other, but they’re both inhibiting each other. Did that make sense?
Andrew: Yeah, yes. Yeah. Kind of like the soy issue with the trypsin inhibitors, that sort of…
Kira: Yeah, yeah. So, again, when I’m working with inflammatory bowel disease, we’re going very slow and steady. It’s not like, “Oh my gosh, you need this amount,” and going really hard. It’s that slow build-up of very easily digestible, pre-digested proteins, or we’re looking at, you know, food aids or digestive aids, whether we’re using herbs, or, herbs supplements, digestive enzymes. But making sure those aren’t actually making the situation worse and irritating. I find, with inflammatory bowel, you just have to be so careful. And I do tend to use a lot of liquid forms of… Yeah, I use a lot of liquids. I use a lot of smoothies, kind of meal replacement, kind of shakes, not like bought shakes, but like ones we make up, just for that ease of digestion. And then you can also really look at getting in those anti-inflammatory nutrients at the same time. So we’re looking at medicinal smoothies, really.
Andrew: Yeah. What about using collagen there as well? I’m thinking about, you know, reinvigorating, regrowing the villi, particularly in celiac disease, things like that, other malabsorption syndrome. But also in regenerating, you know, tight gap junctions and the whole inflammatory cascade that breaks down the TMJs with inflammatory bowel disease, things like that, do you tend to increase the amount of collagen in these patients at all?
Kira: Yes. And again, because we’ve bantered on so much about whey before and how useful it is, in somebody with inflammatory bowel, that’s probably the last thing that I’m going to go for. So, my protein powder of choice these days tends to be collagen for people like that because I find it so gentle and easy on the system; plus, you have, you know… How many things does…? If you look at the list of what collagen actually helps, it’s just phenomenal. And so, you know, if you think about the help with the connective tissue via collagen, it’s just, how could we not be using it? Yeah.
Andrew: Gotcha. Kira, yet again, there’s a volume of stuff we could go on about.
Kira: Well, it’s something [crosstalk 00:48:50].
Andrew: I know, there’s so much that we haven’t covered. Perhaps we can get you back on to cover other parts that we really just poked at today. But thank you so much for taking us through. I mean, you’ve got a wealth of expertise. I know that I jibe you about it, but 25 years of expertise in clinic. But you’ve…
Kira: But I think it’s 26 right now.
Andrew: Twenty-six, okay. You’re even older than I thought. But you…to me, it’s testimony to the dedication that you’ve showed your patients. And I would say, also, not just your patients, but indeed, the next generation of naturopaths that you are teaching because you lecture at university. So you bring this wealth way down the line. We have a lot to thank you for. But thank you so much for taking us through your expertise in this on “Wellness by Designs” today.
Kira: Aww. Thanks for having me. And, you know, for me, it’s very much about the practical rather than… I try to go sciencey for you, but so much of what I do is much more around the practical, what’s working. So, hopefully, there’s some really good takeaways from that.
Andrew: Well, that’s our next podcast; we’re gonna go through exactly what you do with patients to help their lives. So, thank you very much.
Kira: See ya. Thanks.
Andrew: And remember, we can catch up on all the other podcasts and indeed the show notes from today’s podcast on the Designs for Health website. Thanks so much for joining us. I’m Andrew Whitfield-Cook. This is “Wellness by designs.”