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Hello Everyone, Here is another edition in the monthly "Amuse-Bouche" series. Just like a morsel (more like an entrée today) compliments of the chef, these small but critical scientific bites are intended to stimulate thinking about health. I hope you enjoy them. These go out on the 1st of every month. Want to sign up for your own monthly Amuse-bouche op-ed series, in case this was forwarded to you? Go here. I Will Huff, I Will Puff… and I Will Blow Your House In!Almost everyone who knows me well knows that I talk about protein ad nauseam. We all want lean, muscular, strong, healthy bodies. Be sharp as a tack. I don’t hear anyone say otherwise. We all work towards this goal to the best of our ability and means. Yeah? Now, let’s try a thought experiment. Say I want to build a house. I have a plan and electricity (calories or energy), but no building material. Without bricks aka protein, nothing gets built. If I buy less than the projected amount, a section of the house will remain weak or unbuilt. If I buy cheap plywood, I cannot expect it to turn into walnut. Our bodies are that house. We spend our entire lives in them. We can have the cleanest diet and a perfect training plan; if protein intake is low relative to what we need, the house stays vulnerable. If the house needs maintenance, repairs, or remodels: healing, training, recovery, we require more protein, not less. Calories and micronutrients matter, but they cannot replace protein. Proteins: provide amino acids with nitrogen, and sometimes sulfur, allowing construction of body proteins and nucleic acids. Carbohydrates: lack nitrogen, so they supply energy but not the chemical groups needed to assemble new tissues. Micronutrients: supply essential atoms or act as enzyme helpers, but they are not structural polymers.
Only proteins, amino acids, supply the raw subunits for building and repairing tissues, while carbs and micronutrients fuel and enable these processes. I would never buy less than the recommended amount of material to build a house. I know I could never get away with it. Think of the three little pigs. They almost didn’t get away with it. The wolf blew away all but the strongest house made of bricks. HeadwindsThe word protein is derived from the Greek proteios, of first importance. No kidding. With the cultural pressures we are all under, eating food and having an appetite are often treated as moral failings. Thinness is equated with discipline (sometimes, not always) and health (sometimes, not always). It is troubling that even in food-rich countries, relative to size and desired activity level, protein shortfall is ubiquitous. The consequences of chronic protein insufficiency, years of just miss days, especially in people who train, restrict, or graze on low protein snacks, are visible if you pay attention. The difference between a sturdy, well built body and a frail one. Hollowed temples, sagging skin, thinning hair, brittle nails, a certain delicateness, chronic slow to heal musculoskeletal injuries, often point to low protein intake. And yes, overweight and protein deficient can coexist. Plenty of calorie-dense foods potentially with not enough protein. To put it bluntlyWe are not talking starvation or extreme restriction of protein here. Chronic protein deficiency is insidious and subtle. Often we don’t know that we have it. This impacts all our vital organs. Sudden extreme weight loss will do the same. Heart and cardiovascular system Cardiac muscle wasting. The heart is a muscle. With protein deficiency, just like muscles elsewhere it thins or atrophies. Reduced cardiac output. A weaker muscle means a weaker pump and that means poorer circulation to every organ. Arrhythmias. The electrical system is affected by the thinned muscle and changes inside the muscle cells, increasing dangerous rhythms. Heart failure. In severe cases, muscle loss leads to congestive heart failure.
Brain and nervous system Neurotransmitter shortfall. Many are made from amino acids. Deficiency can drive depression, anxiety, cognitive impairment, and mood disorders. Atrophy in severe cases. Brain tissue can shrink, with potentially permanent damage.
Immune system The cascade
These systems are interconnected. A weak heart reduces perfusion to everything else. Low albumin disrupts fluid balance. Impaired immunity lets infections overwhelm us. Skeletal muscle, the protein bank, the 401k
When dietary protein is inadequate, the body withdraws from muscle to protect vital organs. It is a losing strategy. Breakdown by-products add metabolic stress. Less muscle lowers metabolic rate. Eventually the bank is depleted. We want to keep our account full and avoid withdrawals. Recovery challenges
Organs do not always recover in the order they were damaged. Some changes, especially in the brain and immune system, may be only partially reversible, even after repletion. Protein deficiency dismantles the body’s ability to maintain itself at a fundamental level. Compounded deferred maintenance of our house. Backup batteryProtein can be burned for energy. Carbs and fat cannot become protein. In calorie deficit, we strip nitrogen and burn muscle, like burning furniture for heat. Tomorrow there is nothing to sit on. Muscle lost at 40 becomes weakness at 50 and fragility later. You can make catch up contributions, but recovery is partial. The math of aging (or not)After 30 we lose 3 to 8 percent of muscle per decade. With adequate protein and resistance training, it can reduce to 1 to 2 percent! Less protein on the other hand pushes losses higher. Add relative energy deficiency, RED-S, and the body cannibalizes tissue. Starting from 100 percent at age 30, here is what may remain by 80: Optimal protein, 1.2 to 1.6 g per kg daily plus strength training, about 88 percent of muscle mass Standard intake, under 0.8 g per kg, about 35 percent of muscle mass RED-S, under eating, about 22 percent of muscle mass
That is independence versus dependence. When muscle mass drops low enough, the body behaves like an obese person. Sarcopenic obesity. Skinny fat. Doc, I am trying to lose weight. This is too much protein!Protein steadies glucose and insulin, nudges glucagon, and protects lean mass. Cut calories without protein and you lose muscle, spike hunger, and rebound fat. The body reads famine. Protein stops that. With GLP-1s, semaglutide or tirzepatide, appetite shrinks and, without care, up to about 40 percent of weight lost can be muscle. Now the weight is lower, but the body fat mass has gone up. Not what we want. Doc says increase protein, but you are not hungry. The body needs higher protein intake. Eat the protein first, then everything else. Think of GLP-1s as tools to help reduce riff raff: half portion of pasta or rice not a full one, desserts, snacks. If your medication dose does not allow you to eat enough food, and you are not losing weight, the GLP-1 dose needs to go down, not up. Track body composition with clinical grade DEXA, not just weight. Then you can really see whether fat loss has occurred or have we sacrificed muscle. Measure the waist or thigh along with the weight. Measurements often improve before the scale does. These are excellent medications, but incorrectly managed can have serious cardiac, neurologic, and other consequences. Chicken LittleBaseline: 1.5 g protein per kg per day (pounds x 0.68) Higher needs: 1.6 to 2.2 g per kg per day if training hard, trying to lose weight, on GLP 1s, or over 60 Example, 160 lb: about 110 g per day, split across meals What 30 to 40 g looks like, small volume: about 5 oz chicken, 6 oz fish, 12 oz tofu, 1 and 1/4 cups whole milk Greek yogurt or cottage cheese
Let’s goChoose your favorite anchors for the week: grilled chicken, salmon, egg salad, tuna salad, burrito fillings, beans, chickpeas. Shop for them once a week.
Stat protein boosters: boiled eggs, aged cheese, Icelandic or Greek yogurt, smoked salmon, low sugar jerky, cans of beans and tuna, broiled tofu, chili.
Lift: 1 to 3 days per week.
Nutrition buys the bricks. Training tells your body where to place them.
Consider a two week experiment. Protein first at every meal, no skipped meals, whole foods. If weight is steady or down, clothes fit better, and energy improves, you added muscle and trimmed fat. Measurements often precede weight loss. Use accurate, hospital grade DEXA machine to check body composition. All of this is what I have personally practiced, and recommended to my patients for the last 15 years. Everything down to the silly analogies. No one can blow your house in. _________________________________________________________________ The Holy GrailA small volume meal with real food, 35 to 40 grams of protein and 450 kcal or less. Does that even exist? Icelandic or Greek Yogurt and Eggs: 10 oz whole milk Greek yogurt and berries, 2 boiled eggs. About 39 to 42 g, 380 to 420 kcal. Smoked Salmon Scramble and local bread: 3 whole eggs and 3.5 to 4 oz lox and chives and 1 slice bread. About 36 to 40 g, 360 to 410 kcal. Chicken Tacos, 3 corn tortillas: 4.5 to 5 oz shredded chicken and onion and cilantro and salsa. About 36 to 38 g, 390 to 420 kcal. Shrimp or Burrito Bowl, 1/3 cup rice: 6 oz shrimp, garlic lime sear, 1/3 cup cooked jasmine rice, Brussels sprouts. About 36 to 38 g, 350 to 400 kcal. Turkey or Chicken Yogurt Ranch Wrap, 8 inch: 5 oz roasted turkey and 2 tbsp Greek yogurt, romaine and tomato. About 38 to 40 g, 350 to 390 kcal. Grass fed steak and arugula: 5 oz grass fed sirloin, quick sear, arugula and lemon, 1 tbsp chimichurri. About 38 to 40 g, 360 to 420 kcal. Egg Scramble with Bacon and Greek Yogurt: 3 whole eggs, 2 slices bacon, 5 oz whole milk Greek yogurt. About 38 to 40 g, 440 to 445 kcal. Tuna Chickpea Wrap: 5 oz tuna and 1/3 cup chickpeas, 2 tbsp Greek yogurt, lemon, parsley in an 8 inch tortilla. About 40 to 42 g, 380 to 420 kcal.
Plant forward Tofu and Edamame Soba: 7 oz tofu and 3/4 cup edamame and 2 oz soba, tamari vinegar. About 39 to 41 g, 410 to 440 kcal. Tempeh Street Tacos: 6 oz tempeh, adobo, lime, cilantro. About 36 to 38 g, about 420 to 450 kcal.
Whole foods, quick, repeatable. Substitute other whole food proteins with impunity. Play with spices, limes and lemons for flavor. Eat different types of protein- legumes, nuts, eggs, dairy, meat, fish. Eggs are (were) cheap and a complete protein with all essential amino acids.
To get my complimentary BETA guide to HEALTHY PROTEIN HACKS, please send a message here. Medical disclaimer: This article is education, not medical advice. Please contact your medical provider or a certified dietician for advice. Consider forwarding this to a loved one: inadequate protein intake is critical and has long term, serious health consequences. Notes: In my last article, I discussed the mechanics of the foot and talked about zero-drop shoes (Altra Lone Peak or Superior). I have used them for 15 years. For anyone who is not used to these types of shoes, a slow transition is recommended otherwise they can cause tendinitis or worsen foot problems. Secondly, when we talk about gripping the floor, it is more like making contact with the floor with the entire underside of our feet. If we create hammer toes, with an anxious rigid curling of the toes, that is neither necessary or healthy. Use silicone toe separators and that will help making contact with the floor properly. Please work with your physician, a physical therapist, podiatrist or certified personal trainer.
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