April 10, 2018

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Fuel Better at Every Age:The Role of Nutrition for Improved Body Composition and Strength

Stuart Phillips, PhD, FACN, FACSM

Jim White, RD, ACSM EX-P

2

Awarded for 1 Continuing Education Credit

–Commission on Dietetic Registration (CDR)

Certificates will be awarded via email

–Claim credit no later than May 17, 2018

–Contact AKH Inc. with questions: dcotterman@akhcme.com

Webinar is being recorded

–Will be available at www.beefitswhatsfordinner.com

CONTINUING EDUCATION INFO

JIM WHITE, RD, ACSM EX-P

3

• Nationally recognized registered dietitian nutritionist,

past spokesperson for the Academy of Nutrition and

Dietetics and an American College of Sports Medicine

Exercise Physiologist

• Owner of three Jim White Fitness and Nutrition Studios,

three medical nutrition therapy practices and a

workplace wellness corporation

• Quoted in thousands of publications and featured in

hundreds of television and radio segments nationwide

with experience conducting seminars, interviews and

appearances all around the country

• Enjoys giving back through his very own non-profit, the

LIFT Fitness Foundation, which focuses on creating a

foundation of wellness to empower individuals in need.

DISCLOSURE – JIM WHITE, RD, ACSM EX-P

4

STUART PHILLIPS, PHD, FACN, FACSM

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• Tier 1 Canada Research Chair in Skeletal Muscle

Health.

• Director of Physical Activity Centre of Excellence

(PACE) and McMaster Centre for Nutrition,

Exercise, and Health Research.

• Professor in kinesiology and adjunct professor in

the School of Medicine at McMaster University.

• Research focused on the impact of nutrition and

exercise on human skeletal muscle protein

turnover, and diet- and exercise-induced changes

in body composition.

DISCLOSURE – STUART PHILLIPS, PHD FACN, FACSM

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• Former consultant: Nestec AS – Nestlé SA

• Former consultant: Ajinomoto

OBJECTIVES

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• Define the role of the diet, including high-quality protein, in building and repairing

muscle.

• Translate evidence-based research on the role of high-quality protein in supporting

improved body composition and physical and mental strength.

• Share practical application tips with peers and clients, including physical activity

tips and nutrition information on how to include high-quality protein foods in a

healthy dietary pattern at various life stages.

Stuart M. Phillips, Ph.D., FACN, FACSM Professor, McMaster UniversityOntario, Canada

@mackinprof

FB: www.facebook.com/SMPPh.D

E: phillis@mcmaster.ca

single fact

an additional 30 plus years to life expectancy

Age (yr)

Early Adult Older

Mu

scle

ma

ssM

uscle

fun

ction

Birth 20 30 40 50 60 70 80 90

Disability threshold

Time (h)

protein proteinRat

e o

f M

PS a

nd M

PBMPS MPB

protein

T.A. Churward-Venne, N.A. Burd, and S.M. Phillips. Nutr. Metab. 9(1): 40, 2012.

Time (h)

protein protein

Rat

e o

f M

PS a

nd M

PBMPS MPB

protein

T.A. Churward-Venne, N.A. Burd, and S.M. Phillips. Nutr. Metab. 9(1): 40, 2012.

Variations in protein synthesis affect muscle mass: affected by protein ingestion and loading

What can offset muscle loss in aging?

P R O T E I Nand

A C T I V I T Y

resistance exercise

muscle strength

resistance exercise

muscular strength

muscular strength

Muscular strength

Muscular strength

muscular strength

muscular strength

• Aging is associated with reduced food intake, predisposing to energy-protein

undernutrition (Morley, AJCN, 1997)

• N excretion, muscle area, & strength, decreased in older subjects fed an isocaloric diet

containing the protein RDA (Campbell et al, J Gerontol, 2001)

• Older adults may need more protein than the RDA: 1.0-1.2g/kg/d to maintain muscle

mass and even greater benefit may be seen with higher intakes (

• Older adults are not consuming these intakes! (Fulgoni, AJCN, 2010)

↑25-50%*

↑50-88%*

↑150%*

Pro

tein

Le

vels

1. DRIs for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). (2005) National Academy of Sciences. Institute of Medicine. 2. Bauer J et al. Evidence-based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group. JAMDA. 2013;14:542-59. 3. Deutz NEP et al. Protein intake and exercise for optimal muscle function with aging: Recommendations for the ESPEN Expert Group. Clinical Nutrition (2014) In Press; http://dx.doi.org/10.1016/j.clnu.2014.04.007.

0.8g/kg

RDA (19+yrs)1

1.0-1.2g/kg

Minimumprotein intake

for healthy people2,3

1.2-1.5g/kg

Acute or chronic

disease2,3

Up to 2.0g/kg

Severe illness or injury,

or marked malnutrition2

Current1 New Recommendations >65 years2,3†

*increase above current Protein RDA1

†Older people with severe kidney disease who are not on dialysis may need to limit protein intake.

Adjusted lean mass (LM) loss by quintile of energy-adjusted total protein intake. n = 2066.

Houston D K et al. Am J Clin Nutr 2008;87:150-155 ©2008 by American Society for Nutrition

0.7 0.8 0.85 0.9 1.0

0 . 0 0 . 1 0 . 2 0 . 3 0 . 4 0 . 5 0 . 6 0 . 7

0 . 0 0

0 . 0 2

0 . 0 4

0 . 0 6

0 . 0 8

0 . 1 0

0 . 1 2

0 . 2 4 g / k g ( 0 . 1 8 - 0 . 3 0 )

P r o t e i n ( g / k g )

MP

S

0 . 0 0 . 1 0 . 2 0 . 3 0 . 4 0 . 5 0 . 6 0 . 7

0 . 0 0

0 . 0 2

0 . 0 4

0 . 0 6

0 . 0 8

0 . 1 0

0 . 1 2

0 . 3 9 g / k g ( 0 . 2 1 - 0 . 5 7 ) *

P r o t e i n ( g / k g )

MP

S

Moore et al. J. Gerontol. A Biol. Sci. Med. Sci. 70(1): 57-62, 2015

Time (h)

protein protein

Rat

e o

f M

PS a

nd M

PBMPS MPB

protein

Time (h)

proteinproteinR

ate o

f M

PS a

nd M

PBMPS MPB

protein

and muscle performance

What amount of beef is optimal to stimulate MPS with/without exercise?

0g 57g 113g 170g0.000

0.025

0.050

0.075

0.100

*

*FED

FED+EX

MPS

(%

• h

-1)

Robinson et al. Appl. Physiol. Nutr. Metab. 38(2): 120-5, 2013

170g of beef (6oz) is optimal to stimulate MPS

with/without exercise

3. Mustafa J, Ellison RC, Singer MR, Bradlee ML, Kalesan B, Holick MF, et al. Dietary Protein and Preservation of Physical Functioning Among Middle-aged and Older Adults in the Framingham Offspring Study. Am J Epidemiol. (2018)

1 9 9 2 1 9 9 6 2 0 0 0 2 0 0 4

1 6

1 8

2 0

2 2

2 4

2 6F

un

ctio

na

l S

ta

tu

s S

co

re

< 0 . 8

0 . 8 - 1 . 1

> 1 . 2

Mustafa et al. Am. J. Epidemiol. In press, 2018

Mustafa et al. Am. J. Epidemiol. In press, 2018

nutrient-rich

nutrient-rich sources of protein

reduce energy intake nutrient-dense foods

*

*

*

*

* Good – Excellent sources of protein and amongst the top 10 protein-containing foods (NHANES 2007-2010) currently consumed by Americans

no data

• There are no data that link higher protein diets to renal disease: the FAO/WHO report says this, as does the current IOM document that sets the DRI for North Americans

not related to progressive decline in kidney function

• There are no data that link higher protein diets to renal disease: the FAO/WHO report says this as does the current IOM document that sets the DRI for North Americans

• In the most recent round of discussions in setting the new DRI, the IOM concluded, “…protein content of diet is not related to progressive decline in kidney function with age.”

can be attenuated by reducing the protein in the diet has no foundation.

•A resource to check out: A Systematic Review of Renal Health in Healthy Individuals Associated with Protein Intake above the U.S. Recommended Dietary Allowance in Randomized Controlled Trials and Observational Studies. Van Elswyk et al. Advances in Nutrition, in press, 2018

• The acid-ash hypothesis: protein and grain foods, with a low potassium intake, produce a diet acid load, net acid excretion (NAE), increased urine calcium, and release of calcium from the skeleton, leading to osteoporosis

Current evidence shows no adverse effects of higher protein intakes.

only the LS showed moderate evidence to support benefits of higher protein intake.

• The acid-ash hypothesis: protein and grain foods, with a low potassium intake, produce a diet acid load, net acid excretion (NAE), increased urine calcium, and release of calcium from the skeleton, leading to osteoporosis

• Meta-analysis (Shams-White et al. Am J Clin Nutr. 2017): “Current evidence shows no adverse effects of higher protein intakes. Although there were positive trends on BMD at most bone sites, only the LS showed moderate evidence to support benefits of higher protein intake.”

protein's positive effect on bone health is augmented by increased calcium intake only be beneficial under conditions of adequate calcium intake.

Stuart M. Phillips, PhD, FACN, FACSM

Professor, McMaster University

@mackinprof

FB: www.facebook.com/SMPPh.D

E: phillis@mcmaster.ca

2PRACTICAL APPLICATION

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“STRENGTH AND GROWTH COME ONLY THROUGH CONTINUOUS EFFORT

AND STRUGGLE.”

- Napoleon Hill

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“If you don’t use it, you lose it”

J Am Geriatr Soc. 2003 Mar;51(3):323-30.

After age 40, untrained people typically lose

8 percent or more of their muscle mass each

decade.

Study shows by maintaining muscle mass you can reverse the process of muscle decline.

60Wroblewski AP, et al. Phys Sportsmed. 2011 Sep;39(3):172-8.

61

PHYSICAL ACTIVITY• Fitness tips for improved body composition, physical strength and

mental stamina.

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PHYSICAL ACTIVITYBODY COMPOSITION is used to describe the percentages of fat, bone, water and muscle in human bodies

• Weight training

• Healthy diet

• Cardiovascular training

BODY FAT AND LEAN MUSCLE MASS MEASURED BY:

• Hydrostatic weighing - 98% Accuracy

• Bod Pod - 97.7-99% Accuracy

• DEXA Scan - 95-98% Accuracy

• Skin fold measurements - up to 89.4-92.4% Accuracy

• Bioelectrical impedance - 90-93% Accuracy

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BODY FAT PERCENTAGE

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Cardiorespiratory Endurance

• American College of Sports Medicine recommends for weight and body fat loss, 50-60 minutes per day to a total of 300 minutes moderate exercise.

Weight training

• Adults should train each major muscle group two or three days each week using a variety of exercises and equipment.

• Two to four sets of each exercise will help adults improve increase in lean muscle mass.

• For each exercise, 8-12 repetitions improve muscle growth.

TIPS FOR IMPROVED BODY COMPOSITION

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Resistance Exercise

• Adults should train each major muscle group two or three days each week using a variety of exercises and equipment.

• Sets: Two to four sets of each exercise will help adults improve strength and power.

• Volume: 8-12 repetitions for novice to intermediate; 2-6 sets of 1-8 repetitions for advanced.

• Rest period: 2-3 min for higher intense exercises that use heavier loads; 1-2 minutes between the lower intense exercises with light loads.

TIPS FOR IMPROVED PHYSICAL STRENGTH

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• Sleep

• Reduced Stress

• Time Management

• Use Visualization

• Find Balance

TIPS FOR IMPROVED MENTAL STAMINA

https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/sleep-disorders

https://www.apa.org/news/press/releases/stress/2017/state-nation.pdf

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NUTRITION

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70

• Incorporating high-quality protein into the diet

• How to use beef to fuel strong bodies and minds across the lifespan.

• Recipes and meal planning using various high-quality protein

• Early years

• Adulthood

• Later years

• Specific populations: active lifestyle, pregnancy, certain disease states

NUTRITION

PROTEIN’S ROLE IN A HEALTHY LIFESTYLE

Part of a Healthy

Diet

Weight Mgmt

Building Muscle

Increased Energy

Keeps Me Full

Longer

Leidy HJ, et al. Am J Clin Nutr 2015;101:1320S-9S.

Paddon-Jones D, et al. Am J Clin Nutr 2015;101:1339S-45S.Paddon-Jones D, et al. Am J Clin Nutr. 2008;87:1558S-61S.

WHAT DOES “LEAN” MEAN?

USDA. A guide to federal food labeling requirements for meat, poultry, and egg products. 2007.

Lean

<95 mg cholesterol

≤4.5 g saturated

fat<10 g

total fat

(per 3.5 ounces

cooked beef)

MANY OF AMERICAN’S FAVORITE CUTS ARE LEANNearly 65 percent of all beef muscle cuts sold in grocery stores are considered lean

*Per 3.5 ounces cooked serving

IRI/Freshlook, Total US MULO, 52 weeks ending 10/29/17; Categorized by VMMeat System

USDA, ARS. 2015. U.S. Department of Agriculture National Nutrient Database for Standard Reference, Release 28.

U.S Department of Agriculture. A guide to federal food labeling requirements for meat, poultry, and egg products. 2007.

Most popular lean beef

steaks in the retail meat

case:

Strip Steak

Top Round

Top Sirloin

Bottom Round

Tenderloin

Most popular lean beef

steaks chosen at

restaurants:

Tenderloin/Filet

Top Sirloin

Top Loin (Strip)

Flank Steak

Meet Grant

CASE STUDY

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Before AfterSTATS

• Weight Loss: -40 lbs

• Body Composition: Lost 15% body fat

• Muscular Strength: Bench press 1RM

increased from 95lbs to 275lbs

• Mental Stamina: Starting Navy Seal

BUDS Training.

State: Early Years

CASE STUDY

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• 8 ounces leftover cooked steak, cut into very small pieces

• 1 white potato, peeled and cut into small cubes

• ½ lb brussels sprouts, cut in half and ends removed

• 1 red pepper, cut into chunks

• 1 small onion, diced

• 2 Tbsp minced garlic

• 5 washed white button mushrooms, chopped or sliced

• 1 tsp cayenne pepper

• 1 tsp paprika

• 1 Tbsp olive oil

• Salt and pepper to taste

1. In a large skillet, heat olive oil on medium-high

2. Add sweet potatoes and brussels sprouts to skillet and cover for 5 minutes. Uncover and cook, stirring

frequently, for another 5 minutes.

3. Add peppers, onions, and garlic to skillet and cook uncovered for 8-10 minutes, stirring occasionally.

4. Add mushrooms and steak and cook until both are heated through.

5. Season with cayenne pepper, paprika, and salt and pepper if desired. Stir and serve.

*Makes 3 servings, 275 calories per serving, 25 grams protein

Grant’s Favorite High-Protein Recipe – Steak Breakfast Hash

Meet Grant

CASE STUDY

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State: Early Years

“Despite being very athletic, I have always struggled with weight gain. I tried countless diets and worked with personal trainers in the past, but to no avail. When I was 13 years old I began to incorporate more nutritious foods into my diet like lean proteins and vegetables, and the weight quickly began to come off. One of my favorite go-to meals was this steak breakfast hash which helped me feel strong and recover quickly after a hard workout, plus who doesn’t love steak in the morning after a grueling workout?

Over the next several months, I was losing about two pounds per week and have lost over 40 pounds and have completely transformed my lifestyle. Fitness and nutrition have become part of my daily routine and will continue to be part of my future.”

Meet Jean

CASE STUDY

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Before AfterSTATS

• Weight Loss: -30 lbs

• Body Composition: Lost 10% body fat

• Muscular Strength: Biked 100 mile

race

• Mental Stamina: Confidence has

increased and she feels like she can do

anything.

State: Adult

Jean’s Favorite High-Protein Snack Recipe – Mango Ginger Protein Ball

CASE STUDY

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• 1.5 C Almond Meal

• 1.5 C Oat Flour

• 1/3 C Protein Powder, vanilla

• 2 C Dehydrated Mangos, chopped

• 1 C Walnuts, raw

• 1/2 C Medjool dates, chopped

• 1/4 C Maple Syrup

• 1t Ginger, fresh and grated

• 1t Lemon Zest

Mix in food processor until wet. Form into compressed balls with large melon baller.

100 calories, 11 grams protein, for each ball 1.25" in circumference.

“Riding my first century [a bicycle ride of 100

miles] had been an elusive goal until my trainer

and dietitian created a plan, provided

encouragement and gave me confidence. We

timed my training perfectly, and I lost 30 pounds

and gained strength in the process. I completed

day one 100 miles in great form and followed

that with 75 miles day two of the Bike MS. One of

my favorite snacks to fuel me through those

miles were these Mango Ginger Protein balls.

The higher protein yet lower calories helped

me feeling fuller longer and being satisfied

yet it didn’t leave me feeling overly stuffed as I

biked throughout the day. What’s next? The

possibilities seem endless!”

Meet Lynn

CASE STUDY

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Before AfterSTATS

• Weight Lost: -72 lbs

• Body Composition: Lost 14% body fat

• Muscular Strength: Is able to do step

ups with 10 lbs

• Mental Stamina: Started dating again,

traveling, decreased depression.

State: Later Years

CASE STUDY

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“The need for many seniors to lose weight and shape up has been in the news lately. In one story, a doctor doubts “whether you’re going to see people lose 50 to 100 pounds as they’re older.” Oh, really? This senior has lost over 70 pounds since first waddling in to see a dietitian and personal trainer— with borderline diabetes — less than a year ago.

It hasn’t always been easy but my dietitian managed to change my eating habits so I don’t miss the bad old stuff; and we keep tweaking the plan so it’s something I can live with permanently. My dietitian taught me that incorporating protein helps to build and maintain muscle. Not only that, but it helps continue the fight against type-2 diabetes and osteoporosis, all pesky diseases that seem to be more prominent in my mature stage of life.”

Meet Lynn

State: Later Years

Meet Jenny

CASE STUDY

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Before After STATS

• Weight Lost: -14 lbs

• Body Composition: Lost 6% body fat

• Muscular Strength: Leg press before:

110lb | now: 200lbs

• Mental Stamina: Has more energy to

handle workday, take care of 2 girls,

and to live strong through the day.

State: Special Populations, Active

Sample Meal PlanCASE STUDY

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Jenny’s Meal Plan - BEFORE

• Breakfast: 1 cup of sugary cereal with milk

• Snack: Skipped

• Lunch: Chicken ranch wrap with chips and

a coke

• Snack 2: Gold fish

• Dinner: 2 slices of pizza

• 14 glasses of wine/week

Jenny’s Meal Plan – AFTER (Competition Diet)

• Breakfast: 3 eggs + 1 whole egg, veggies and

½ cup oatmeal

• Snacks: 1 protein shake (1 scoop of whey

protein) with almond milk and berries or 1

Greek yogurt with walnuts and strawberries

• Lunch: 4 oz chicken, 1 cup brown rice and 1

cup cooked veggies

• Dinner: 4 oz flank steak, 1 cup of sweet

potatoes and 1 cup of cooked brussels sprouts

• Only 2 glasses of wine/week

Meet Krista

CASE STUDY

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During After STATS

• Body Composition: Gained an 8 lbs 10

oz healthy baby.

• Muscular Strength: Focused on

consistent weight training 2-3x a week

up until birth

• Mental Stamina: Focused on deep

breathing and meditation to get ready

for natural child birth.

State: Special Populations, Pregnancy

Key Notes: Throughout pregnancy, your body needs about 10 extra grams of protein each day to

support the growing baby.

Sample Meal PlanCASE STUDY

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Krista’s Meal Plan – BEFORE Pregnancy

• Breakfast: Bagel with light cream cheese

• Snack 1: Skipped

• Lunch: Turkey sandwich with crackers and

fruit

• Snack 2: Skipped

• Dinner: Crackers with cheese and fruit

• 1 small dessert and glass of wine

Krista’s Meal Plan – During Pregnancy

• Breakfast: 2 whole grain waffles with 2 tbsp

almond butter and fruit

• Snack 1: Rotisserie Chicken with crackers and

baby carrots

• Lunch: Chipotle Bowl with black beans, steak,

brown rice, lettuce, salsa and guacamole

• Snack 2: 1 Greek yogurt with hummus and

veggies and fruit

• Dinner: Salad with grilled chicken and a small

sweet potato

Meet Mark

CASE STUDY

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Before After STATS

• Weight Loss: -90 lbs

• Body Composition: Lost 13.7% body

fat, 6.9 increase in skeletal mass

• Muscular Strength: Increased 7

pushups to 37 pushups

• Mental Stamina: Improved mental

stamina for his work as computer

scientist, more energy to play with

grandchildren, can drive for first time

in years. Went from body age of 80 to

56.

• Health Status: Went off his cholesterol

and blood pressure medications, off C-

pap machine and no more episodes of

vertigo.

State: Special Populations, Disease State

Sample Meal PlanCASE STUDY

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Mark’s Meal Plan - BEFORE

• Breakfast: Eggs with cheese, grits with

butter and a muffin

• Snacks: Skipped

• Lunch: 12 inch sub with chips and 20 oz

mountain dew

• Dinner: Lasagna with Caesar salad

• Late night snack: Ben and Jerry’s Ice

cream, chips, cookies

• 3 beers/night

Mark’s Meal Plan - AFTER

• Breakfast: ¾ cup plain nonfat Greek yogurt, ¼

cup low-sugar granola (plain), 6 almonds,

½sliced banana

• Snacks: 1 oz reduced-fat cheese with 1 serving

whole-grain crackers or 1 rice cake with 1

tablespoon nut butter and 1 teaspoon dark

chocolate chips

• Lunch: Lean burger - 4 oz 96% lean beef, 1

slice alpine lace cheese, 1/8 avocado slice,

lettuce, tomato with whole wheat bun and baby

carrots.

• Dinner: 4 oz salmon, 1.5 cups cooked quinoa

and 1 cup of broccoli spears

• Late night snack: 1 cup Halotop chocolate ice

cream

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3Q&A

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Awarded for 1 Continuing Education Credit

–Commission on Dietetic Registration (CDR)

Certificates will be awarded via email

–Claim credit no later than May 17, 2018

–Contact AKH Inc. with questions: dcotterman@akhcme.com

Webinar is being recorded

–Will be available at www.beefitswhatsfordinner.com

Slides

–Will be shared in a follow-up email after the webinar.

THANK YOU