CIA-Harvard Menus of Change National Leadership Summit · 2014-06-16 · The recommended dietary...
Transcript of CIA-Harvard Menus of Change National Leadership Summit · 2014-06-16 · The recommended dietary...
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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
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Protein 101
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Outline Standard Recommendations
Minimum / Optimal / Maximum – CONFUSION?
Quality
Impact of Shifting from Animal to Plant-Based Proteins
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Dietary Reference Intakes (DRI)
Dietary Guidelines
for Americans
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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
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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
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Distribution of Requirement
Protein Requirement
25 grams/day
54 grams/day
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Recommended Daily Allowance (RDA) Population Approach: Add 2 Standard deviations to EAR
Protein Requirement
25 grams/day
54 grams/day
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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
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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
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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)
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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??
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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
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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
Class Exercise: Protein and Energy (Kcal) intake
PROTEIN Intake – Stanford Med Students
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0
50
100
150
200
250
300
0 1000 2000 3000 4000
Protein (grams)
Kcals
EAR
Class Exercise: Protein and Energy (Kcal) intake
PROTEIN Intake – Stanford Med Students
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0
50
100
150
200
250
300
0 1000 2000 3000 4000
Protein (grams)
Kcals
RDA EAR
Class Exercise: Protein and Energy (Kcal) intake
PROTEIN Intake – Stanford Med Students
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Class Exercise: Protein and Energy (Kcal) intake
0%
5%
10%
15%
20%
25%
30%
35%
40%
0 500 1000 1500 2000 2500 3000 3500 4000
% P
rote
in
Kcal
10- 25%
PROTEIN Intake – Stanford Med Students
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Outline Standard Recommendations
Minimum / Optimal / Maximum –
CONFUSION?
Protein Quality
Impact of Shifting from Animal to Plant-Based Proteins
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JAMA, June 25, 2008—Vol 299, No. 24 pp 2891-2893
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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.
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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.
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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
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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.
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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.
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Healt
h (
%)
OPTIMAL intake is typically a wide range
Bounded by marginal deficiency and toxicity
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Outline Standard Recommendations
Minimum / Optimal / Maximum – CONFUSION?
Protein Quality Impact of Shifting from Animal to Plant-Based Proteins
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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
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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?
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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
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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.
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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
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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
7-fold difference
10-fold difference
Amino Acid Distribution (per 40 grams protein): EGG
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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
Essential Non-Essential
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
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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
Essential Non-Essential
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
Limiting amino acid
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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
Essential Non-Essential
Amino Acid Distribution (per 40 grams protein)
Whole Egg
Pinto Beans
0.0
1.0
2.0
3.0
4.0
5.0
6.0
Limiting amino acid
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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
Essential Non-Essential
Amino Acid Distribution (per 40 grams protein)
Whole Egg
Beans and Rice
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Limiting amino acid
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Outline Standard Recommendations
Minimum / Optimal / Maximum – CONFUSION?
Protein Quality
Impact of Shifting from
Animal to Plant-Based Proteins
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…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.
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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
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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
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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)
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Protein Use
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Protein Use
Protein
1. Functional
![Page 48: CIA-Harvard Menus of Change National Leadership Summit · 2014-06-16 · The recommended dietary allowance (RDA) is an estimate of the minimum daily average dietary intake level that](https://reader036.fdocuments.in/reader036/viewer/2022081522/5f8ddd5c6b8b7b02d2559b08/html5/thumbnails/48.jpg)
Protein Use
Protein
1. Functional
No Storage
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Protein Use
Protein
1. Functional
2. Carbohydrate (for immediate need, or
conversion to glycogen)
No Storage
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Protein Use
Protein
1. Functional
2. Carbohydrate (for immediate need, or
conversion to glycogen)
3. Fat (conversion
for energy storage)
No Storage
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Protein Use
Protein
1. Functional
2. Carbohydrate (for immediate need, or
conversion to glycogen)
3. Fat (conversion
for energy storage)
Nitrogen
No Storage
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Protein Use
Protein
1. Functional
2. Carbohydrate (for immediate need, or
conversion to glycogen)
3. Fat (conversion
for energy storage)
Nitrogen
No Storage
NH3
(Ammonia)
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Protein Use
Protein
1. Functional
2. Carbohydrate (for immediate need, or
conversion to glycogen)
3. Fat (conversion
for energy storage)
Nitrogen
No Storage
NH3
(Ammonia)
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Take Home Points Standard Recommendations
Minimum / Optimal / Maximum – CONFUSION?
Quality
Impact of Shifting from Animal to Plant-Based Proteins
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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
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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
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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
Tremendous room for substantial shift from animal to plant protein
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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
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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
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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
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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
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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
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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
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Calories
Protein (g)
Fat (g)
Sat fat (g)
Carbs (g)
Added sugar (g)
Fiber (g)
Two eggs ~150
13
10
3
<1
0
0
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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2011
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2011 MyPlate.gov
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The USDA Food Guide Pyramid
![Page 88: CIA-Harvard Menus of Change National Leadership Summit · 2014-06-16 · The recommended dietary allowance (RDA) is an estimate of the minimum daily average dietary intake level that](https://reader036.fdocuments.in/reader036/viewer/2022081522/5f8ddd5c6b8b7b02d2559b08/html5/thumbnails/88.jpg)
The USDA Food Guide Pyramid
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Beans, Nuts, Fish, Eggs, Poultry, Meat
CONTRIBUTE: Protein, fiber
B6, B12, niacin, thiamin,
folate, Vitamin E
Potassium, zinc,
magnesium, iron
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Beans, Nuts, Fish, Eggs, Poultry, Meat
2-3 servings/day
CONTRIBUTE: Protein, fiber
B6, B12, niacin, thiamin,
folate, Vitamin E
Potassium, zinc,
magnesium, iron
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Beans, Nuts, Fish, Eggs, Poultry, Meat
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)
CONTRIBUTE: Protein, fiber
B6, B12, niacin, thiamin,
folate, Vitamin E
Potassium, zinc,
magnesium, iron
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Beans, Nuts, Fish, Eggs, Poultry, Meat
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)
CONTRIBUTE: Protein, fiber
B6, B12, niacin, thiamin,
folate, Vitamin E
Potassium, zinc,
magnesium, iron
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Beans, Nuts, Fish, Eggs, Poultry, Meat
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
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Milk, Yogurt and Cheese
CONTRIBUTE: Protein
Riboflavin & B12
(Vitamins A & D when
fortified)
Calcium, magnesium,
potassium
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Milk, Yogurt and Cheese
2-4* servings/day
CONTRIBUTE: Protein
Riboflavin & B12
(Vitamins A & D when
fortified)
Calcium, magnesium,
potassium
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Milk, Yogurt and Cheese
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
(Vitamins A & D when
fortified)
Calcium, magnesium,
potassium
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Milk, Yogurt and Cheese
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
(Vitamins A & D when
fortified)
Calcium, magnesium,
potassium
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Milk, Yogurt and Cheese
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
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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
Essential Non-Essential
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
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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
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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