TWBDSciencePresentation TWD Multimedia Standard

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www.csiro.au

High Protein Low Carbohydrate Diets:Targeting Who Benefits

Dr Manny Noakes

Senior Research Dietitian

CSIRO Human Nutrition (Clinical Research Unit)


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Diabetes riskincreases with obesityand will more thandouble, from 140million to 300 millionin the next 25 years.

Diabetes leads toserious complicationssuch as heart, eyeand kidney diseaseand a shortened lifespan.

Costs of obesity tocommunity > $6b/y

Obesity Epidemic


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Other terms that are used thatgenerally refer to the same syndromeinclude:

Syndrome X

Metabolic Syndrome

Insulin Resistance Syndrome

Deadly Quartet

Syndromic Obesity
http://window.close%28%29/


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Constellation of major riskfactors, life-habit riskfactors and emerging riskfactors

Over-represented among

populations with heart disease

Clue is distinctive body-typewith increased abdominal circumference(although some leaner men andwomen can have metabolicsyndrome)

Metabolic Syndrome


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ATP III Guidelines

Glucose AbdominalObesity

HDL-CBP

TG

Glucose 6.1mmol/LWaist Circumference

102cm 88cm

HDL-C 1.0 mmol/L

1.3 mmol/L

BP 130/85 mmHgTriglycerides 1.7mmol/L

Diagnosis is made when 3 or more of these risk criteria are met

Diagnostic Criteria for Metabolic Syndrome


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InactivityAging

Atherosclerosis

Genetics

Obesity

PCOS

Dyslipidemia

Hypertension

Type 2 diabetes

NASH

Genetics

Insulin Resistance: Causes and Associated Conditions

INSULINRESISTANCE


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* Total area under 3-hour response curve (mean of 2 tests). Olefsky JM et al. AmJMed. 1974;57:551-560.

625

500

400

300

200

100

100 200 300 400 500 600

Insulin Response to Oral Glucose*

PlasmaTG

(mg/dL)

r = 0.73

P < 0.0001

Insulin Resistance and Hypertriglyceridemia


8/33Ford ES, et al JAMA 2002

45

35

0

8814 aged 20 years or older from NHANES III (1988-1994)

The age-adjusted prevalence : men (24.0%) women (23.4%)

Prevalence of Metabolic Syndrome

0

5

10

15

20

25

30

35

40

45

20-29 30-39 40-49 50-59 60-69 >70


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Marketing Weight Loss


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Skov et al 1999 High-carbohydrate

(HC, protein 12% energy) n=25

High-protein

(HP, protein 25% energy) n=25

Results After 6 Months

5.1 kg in the HC group

8.9 kg in the HP group (P < 0.001)

More subjects lost > 10 kg in the HP group (35% vs 9%).

HP diet decreased fasting plasma triglycerides significantly.

Protein Versus Carbohydrate in ad libitumFatReduced Diet


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Greater weight and fat loss (Skov et al,1999) Obese subjects

Increased satiety(Latner & Schwartz, 1999)

Glucose tolerant women

Thermic effects (Hwalla Baba et al,1999) Obese, hyperinsulinaemic men

Lean body mass spared (Piatti et al,1994)

Glucose tolerant women

High protein/Low GI (Dumesnil et al) 25% decrease in ad libitum intake

Obese men

Increased Protein / Carbohydrate Ratio


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Insulin sensitivity (Clifton et al,1998) Subjects with IGT

Greater abdominal fat mass loss (Parker et al 2002)

Type 2 diabetes

Greater lowering of LDL-C (Parker et al 2002)

Type 2 diabetes

Thermic effect of HP meal 28% greater (Luscombe et al 2002)

No change in REE

Type 2 diabetes

Greater lowering of TG (Farnsworth et al (in press))

Subjects with elevated insulinLean body mass spared (Farnsworth et al (in press))

Subjects with elevated insulin

Increase Protein / Carbohydrate Ration: CSIRO Studies


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Renal Function

Urinary albumin excretion was notaffected by dietary protein duringweight loss:

N=19 with microalbuminuria.

HP diet: 24.2 to 19.8 mg/l (n=12)

LP diet: 4.3 to 3.5 mg/l (n=7)


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Aim

To compare a high protein weight loss diet with a highcarbohydrate diet in women participating in a 12 weekintervention (and subsequent follow up for 1 year) on thefollowing outcomes:

Weight loss and body composition

Nutrient status

Bone turnover markers

Measures of heart disease risk

.

Diets: High carbohydrate

High protein, high red meat


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High Meat Protein (5600 KJ)

Cereal

Low fat milk (250ml)

Wholemeal bread (2 slices)

Fruit (2)

Beef / lamb 200g - dinner

Chicken/fish/meat 100g - lunch

Vegetables 2.5 cups

Diet Yoghurt 200g

Canola oil 3 tsp

Wine 2 glasses/week (optional)

34% protein 20% fat 46% carbohydrate

109g protein 31g fat 161g carbohydrate


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CerealSKIM milk (250ml)

Wholemeal bread (3 slices)

Fruit (3)

Chicken / pork / fish 80g

Vegetables 2.5 cups

Canola oil 3 tsp

Pasta/rice 120g cooked

Low fat biscuits 3

Wine 2 glasses/week (optional)

High Carbohydrate (5600 KJ)

17% protein 20% fat 64% carbohydrate

57g protein 31g fat 229g carbohydrate


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Overall Results

Diet AverageWeight Loss

Min WeightLoss

Max WeightLoss

N Dropouts

High Protein 7.6kg 0.55kg 18.2kg 51 5

High Carbohydrate 6.9kg 0.15kg 14.5kg 49 16


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Weight Loss by Triglyceride Status

8.2

9.29.3

6.9

3

45

6

7

89

10

Low TG High TG

weightloss(kg)

* Sig Diet Effect

HighProtein

HighCarb


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Arm Fat

Leg Fat

Abdominal Fat

DEXA


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5.13

5.866.28

3.63

0

2

4

6

8

high protein -

low TG

high

carbohydrate-

low TG

high protein -

high TG

high

carbohydrate-

high TG

kg

Total And Midriff Fat Loss - DEXA Data

* Sig Diet Effect

HighProtein

HighCarb


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LDL Cholesterol

2

2.5

3

3.5

4

4.5

5

week 0 week 4 week 8 week 12

LDL-Cmm

ol/L

4.8%HighProtein

HighCarb


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Triglycerides

0.5

1

1.5

2

2.5

3


TG

(mmol/

L)

4%

13%

HighProtein

HighCarb


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Triglycerides by TG status

0

0.5

1

1.5

2

2.5


TG

mmol/

L

HIGH TG

LOW TG

10%

28%

HighProtein

HighCarb


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30

20

10

0

-10

High Protein High Carb

P=0.036

26%

9%

Triglyceride Change By Insulin Status

ChangeinTG

Insulin Split

Low Insulin

High Insulin


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21

4.6

4.4

4.2

4.0

3.8

3.6

3.4

3.2

3.0

2.8

Ca

lciume

xcretionmmol/24hr


Week 0

Week 12

Reference Range:2.5-7.5mmol/24hr

Calcium Excretion

Calcium excretion decreased on both diets


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Protein versus Carbohydrate and Markers of Bone Turnover

Deoxypyridinoline/creatinine ratio Pyridinolone /creatinine ratio

High Protein High CarbHigh Protein High Carb

Both weight loss strategies associated with increased bone turnover.No effect of diet composition.

21

26

24

22

20

18

16

14

12

1021

90

80

70

60

Week 0

Week 12


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21

139

138

137

136

135

134

133

132

131

Haemoglobin

High ProteinHigh Carb

Reference Range:115-165g/L

*

No change

Mean

Week 0

Week 12


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21

310

300

290

280

270

260

250

240

230

Vitamin B12


Reference Range:140-700pmol/L12%

increase

13%decrease

Week 0

Week 12


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Conclusion #1

Moderately High protein high red meat diets andconventional high carbohydrate weight loss diets providehealth benefits.

Plasma triglycerides lowered on average 9%.

LDL cholesterol lowered on average 5%.

Insulin lowered on average 19%.

Glucose lowered on average 4%.


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Conclusion #2

Moderately high protein high red meat diets provideadvantages in women.

Greater weight, fat and midriff loss on high protein diet in thosewomen with elevated TG.

Greater lowering of plasma triglycerides on high protein diet in thosewomen with elevated insulin or TG.

Haemoglobin levels improved more on high protein high red meatdiet.

B12 status improved on high protein high red meat diet.


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Conclusion #3

Moderately high protein diets can be a safe and effectiveoption to conventional high carbohydrate weight loss diets.

For some, HP diet may be easier to follow for longer periods as itmay be more satisfying.

HP diet as used in this study is safe and nutritionally adequate.

It was easier to achieve RDI for all nutrients on HP diet.


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Questions?

Book 1 publishedin May 2005.

Booklet released inAugust 2003 in theAustralian Womens

weekly, then as a freebooklet by Meat &

Livestock Australia(MLA).


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www csiro au

Thank You

CSIRO Human Nutrition

Name Associate Professor Dr Manny Noakes

Title Senior Dietitian / Research ScientistPhone +61 8 8303 8827

Email [email protected]

Web www.csiro.au/twd

Contact CSIRO

Phone 1300 363 400

+61 3 9545 2176

Email [email protected]

Web www.csiro.au
mailto:[email protected]:[email protected]

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