If you would be a real seeker after truth, it is necessary that at least once in your life you doubt, as far as possible, all things. — Rene Descartes
That pondering Frenchman aptly summarizes some of the controversial work I've been doing lately.
As a scientist, I consider myself a seeker of truth. It's an ethical obligation. This isn't always a popular move. You see, not everyone is equally willing to doubt — to question authority. Power and money can be lost. Careers can be harmed. This is true in nutrition and healthcare just as it is in politics or religion.
Regardless, today I'm going to bring up some truths that are particularly inconvenient for guardians of the past.
The Push for Protein Restriction
For decades, protein restriction has been a cornerstone of certain healthcare practitioners' treatment plans. Protein strains the kidneys after all. And it weakens bones, ensures a low fiber diet, and is always a symptom of an unhealthy fast food-based lifestyle. Plus, extra protein makes us fat. Oh, and it can even kill us after several weeks.
No wait, somewhere there I must've gotten carried away. It happens. Oh boy, does it happen. In fact, check out some of the quotes below from college textbooks, personal trainer manuals, and notices from sports governing bodies.
"Overconsumption of protein offers no benefits and may pose health risks. High protein diets have been implicated in several chronic diseases including heart disease, cancer, osteoporosis, obesity and kidney stones..."
"High protein diets also stress the kidneys..."
"Muscle work builds muscle; [protein] supplements do not..."
"Athletes are not only pumping iron these days, they're also pumping protein supplements in hopes of building muscles..."
"In fact, protein consumed in excess of what the body needs will be converted to fat."
"A permissible supplement can contain no more than 30 percent of its calories from protein;" Other language in document: "protect," "warning," "potentially harmful," "risk," "concoction"
I wonder if these educators ever consider that "overconsumption" or "excess" of anything is, by definition, problematic. Excess water can even be deadly. Fancy that.
And from an insider's perspective, here's a quote that was removed from a first draft of the above paper, but nonetheless appears in a college textbook: "Diets very high in protein result in death after several weeks." Hmm. I can only conclude from these educational materials that if you're reading this article as a protein-seeking strength athlete, you're a) foolish and/or ignorant, b) unethical (or at least misguided), and c) lucky to not be diseased, osteoporotic, fat, and... dead.
These quotes are just a portion of what can be found.(16) But why would "experts" say such things? Is it ignorance? Are other forces at work? Maybe both. You see, many just don't know any better. They feed off of each other but lack the awareness or ability to do the necessary research. Ideas get recycled. Dogma prevails.
And there's another possibility. Without embracing this "education" for the "safety of the public," certain healthcare workers could lose a significant part of their practice. (Trust me, these people exist. Maybe you've even met one.)
Think about it: Without warnings to avoid collusion with this ineffectual health offender (ample protein), some educators, practitioners, and consultants simply have less to offer. One of their supposedly helpful pieces of advice is taken away. If they can't use their supposed erudition to steer you clear of purported mistakes like seeking ample protein, they lose a bit of their expert status and value.
And who'd want to hire an ineffectual clinician or consultant whose detailed (lower-protein) treatment plans or professional opinions have been shown to be largely bupkis? What employer would continue paying a professional salary to someone if that person no longer wielded the "big treatment secret" that they once claimed to possess?
Get together a group of such professionals with so much to lose and their official stance might just drift toward a single, supportive side of the scientific literature. Heck, they might even, however unwittingly, use bias in choosing which parts of the literature (if any) go into their evidence libraries or educational materials.
However satisfying or reassuring, this kind of behavior would make them neither a critically-minded doubter nor a seeker of truth. But maybe I'm being a conspiracy theorist. Could it even be possible that a prominent group of leaders might hide or suppress opposing viewpoints? Nah.
Educating the Youth
Think about how many young, healthy college athletes are being taught half-truths or opinionated bias. (I know, I've been asked to teach some of it myself.) At the very least, this "education" would hamper body composition efforts and athletic gains. Let's not even get into the denial of more speculative benefits like increased immune defenses and overtraining prevention.(17)
The truth is, data used to justify such dissuasive messages typically stems from nonathletic older women who under-consumed calcium, selected studies on kidney patients, or parts of the general population that lead an average Western lifestyle. What if you aren't a member of these populations?
One thing you won't hear often is that, despite searches through hundreds of studies, the sum total of subjects used in all accessible athlete-protein safety studies is around 40 individuals.(16) Further, the protein seekers in these studies were compared to subjects rather unlike themselves. Knowing this, terms like "evidence-based practice" sound a little misplaced.
But let's get back to careful documentation of the truth as found in the scientific literature. The publication from where Table 1's quotes were taken concluded: "Results indicate a dearth of population-specific safety data... Nearly all abstracts (75 of 77) were focused upon anabolic efficacy or issues other than safety or chronic diseases. No abstracts specifically compared renal function, bone density, or dietary parameters of resistance trainers with a multi-year history of ample/surplus protein consumption with their non-protein-seeking counterparts."
Indeed, with all the "zeros" showing up in search after search of the scientific literature, again one wonders whether educational, clinical, and wellness practices for students and athletes have indeed been "evidence based."
But nobody's paying for this kind of truth seeking, questioning, or systematic comparison of what's true versus what's done in practice. Skepticism and anti-establishment pursuits don't sell well. That is, scientists and studies aren't eagerly funded by the very groups that stand to have egg on their faces after espousing a relatively anti-protein stance for decades.
Hence, after twenty plus years, we've never really seen it. No money for the study of something can mean silence and ignorance where it might just be needed most. It wouldn't be the first time a big professional group has protected the status quo.
Dr. David Graham shows how FDA managers tried to silence him for indicating Vioxx unsafe.
Let There Be Light
In the absence of (scientific) light, darkness prevails. And that darkness can be difficult to clear away. Leaving "protein concerned" messages scattered, often verbal, and vague makes them hard to argue against. In a pinch, when confronted with irrefutable evidence (or lack thereof) a "nutrition educator" can always defend with, "Uh, I didn't say that."
Clinicians who over-extrapolate the benefits of protein restriction in their practice, lay media that benefit from dramatic messages, and sports governing bodies that like to lay down the law with their own, broad interpretations of unacceptable "ergogenic aids" are left to go about their business.
You can guess that there are potential socio-political and financial reasons why the dogma of lower-protein diets (the RDA is 64 grams daily for an 80-kilo man) has persisted, even for athletes. Promulgating and even exaggerating their appropriateness helps make the purveyor a certified or licensed "expert," someone with the inside track to better health or fair play. As pointed out earlier, educating the public on the dangers of dietary protein actually garners them payment for knowing how to set up lower-protein diets so expertly.
Thus, I have to wonder: Would they really ever investigate disempowering alternatives? Would they yearn to understand the severe limitations and even repercussions of their stance?
You may have noticed that I mentioned fair play above. That's because recommendations against ample protein can even come across as more ethical, in that they're steering "muscle heads" away from some notion of doping or cheating. So, we've got a financial pull toward keeping the protein dissuasion around, we've got a power base and multiple professions to maintain (saving face and not just salaries), and we've even got a seeming ethical high ground that's easy to defend.
Nonetheless, this entrenched, almost anti-protein approach is starting to be questioned by more and more scientists willing to speak out and by reviews offering a more balanced interpretation, from those with bone concerns to renal patients to athletes.(2-5, 10, 16-18, 21, 23, 27)
Since the "animal protein causes heart disease" argument lingered for so long before it was finally laid to rest, I guess it'll be a while for the bone loss, kidney stress, and athletic uselessness arguments to die as well.
Why We're Different
The obvious problem I see — and the purpose of this article — is the over-extrapolation of protein concerns to healthy resistance athletes. Perhaps we're targeted because, despite decades of concerns and warnings, we persist in consuming ample, even surplus protein. Perhaps we're targeted because of some notion that we're just "muscle heads eating tons of protein" (a real verbal statement overheard late last year). Perhaps there's a practitioner counter-culture to the defiant insistence of truly overzealous athletes.
Whatever the case, not only does this population (we) deserve equal treatment, it also has unique characteristics that could make it markedly different from certain diseased or aged groups.
How might we be different? And how could this relate to messages of bone, kidney, and dietary harm? Let's make a list.
1. We load-bear, a well-known potent stimulus for greater bone density (might this counteract any purported bone losses?).
2. We generally don't have pre-existing renal disease (which appears to be prerequisite for consequences like azotemia-induced "kidney stress" and protein-related filtration decline).
3. We typically don't have underlying hyperglycemia and hypertension (which again appear to be prerequisite for consequences like kidney damage).
4. Our protein sources are generally not from fast food restaurants (which might just eliminate the existing [weak] correlation between protein intake and low-fiber, high-fat diets from other populations).
5. Many of us seek vegetables and fiber in general (might this compensate for any renal acidification or constipation?).
I want to point out, however, that however logical, these facts and questions still desperately need scientific evidence to put the concerns to rest. However seemingly obvious to Testosterone Muscle readers, a critical mass of protein truths needs to be systematically observed, recorded, analyzed, and published. Otherwise, at best we can say the protein dissuasion is unfounded — not wrong, just unfounded.
At present, we simply can't be sure that there are absolutely no ramifications to seeking large amounts of protein. Absence of evidence isn't evidence of absence. I'm just being fair here. For example, I don't need a study to tell me that egg whites and skinless chicken breasts are non-fattening, but science is a stepwise process. Plus, previous lay efforts to talk sense aren't sinking into certain protein-wary experts, either.
Raging Against the Anti-Protein Machine
Let me reiterate why things are serious. Until very recently, only lay magazine and website articles have raged against the "anti-protein machine." These impassioned articles and arguments, no matter how vehement or even referenced with semi-related evidence, have been summarily dismissed by healthcare authorities.
What we still don't have, after decades of complaining, is a sizeable body of population-specific, peer-reviewed, published scientific research on the matter. That's what will bring about change. Heck, until 2008, we didn't even have systematic documentation of the (sometimes ludicrous) language surrounding dietary protein.
Disturbingly, what one finds when he looks into the situation, is a phenomenon similar to that which Al Gore fights against with his An Inconvenient Truth movie. (You may have guessed this by now.) Organizations with a vested interest in the status quo are willing to poo-poo the potential damage that's being done.
In Mr. Gore's case, the attempt is as follows:
In our case, it might be:
And to emphasize the disconnect between science and the messages being promulgated to the public, Mr. Gore offered the following data. He was discussing the percentage of published works in doubt that humans are responsible for global warming.
Now, here's where it gets really interesting. Upon seeing this, I was dumbstruck by the similarities with what I've been documenting and researching in the lab. When searching hundreds of peer-reviewed scientific articles, looking for ones that doubt protein safety in athletes, and comparing them with messages from public educational materials that cause doubt, we get this:
But specific to Al Gore comparisons, maybe I'm off base; I concede that my review of public educational materials, with a few students, is by no means exhaustive (even if it was quite random and the results were remarkably consistent). Maybe the similarities between global warming and protein dissuasion are inappropriate to point out. Could the damage to mankind really be significant in the latter case?
For your consideration, I give you the following:
• At last count, roughly seven out of ten Americans are overweight, or worse (protein is known to be satiating and far more thermogenic than carbs or fats).
• About one in four of us have metabolic syndrome (higher protein diets have been shown to improve glycemia, cardiovascular risk, and body composition [11-14]).
• The sarcopenia of ageing and sedentary lifestyles lead to sometimes incapacitating muscle and strength loss (providing amino acids seems to help [29]).
• Cachectic/hypercatabolic states can lead to incapacitating muscle and strength loss (essential amino acids are being suggested as helpful [24]).
• We're drifting very far from the type of protein-rich paleo-diet on which we evolved (your DNA was chosen and your large brain made possible at this time).
• By over-focusing on carbohydrates and lacking proper protein education, Americans miss out on healthy protein choices that have functional food qualities and enhance health (nutrient rich, anti-oxidative, immuno-supportive, etc.).
• NCAA athletes with whom I work are routinely skipping meals and ignoring peri-workout protein windows of opportunity. It's a real shame because regardless of what some are told, protein does enhance the anabolic effect of lifting.(17, 20) In fact, it's now just an issue of dose, with 20 grams appearing optimal for average healthy guys.(20)
We Can Do Better
I realize I'm preaching to the choir here, but telling the public, including healthy students and athletes, to dismiss or avoid ample protein as ineffective or worse doesn't "protect" them. It may even harm them. Who it does protect is the "expert" who — either by ignorance or conflict of interest — continues their practice of under-supported methods and outdated or opinionated "education." If scientific consensus doesn't back up what you're telling people, it's time to give up that line of income. I thought this kind of dogma was finally gone, but clearly it isn't.
Although I'm not supporting super-high protein intakes in this article (which tend to be wasteful, as I've seen in the lab) and I recognize that protein needs are based on individual factors — and I know there are in fact persons who should discuss a higher protein intake with their doctors before starting, we need to heed Mr. Gore's words: "We can do better."
Just as he was imploring, a person to person, family to family approach may be the only recourse — until more data is available. When politically entrenched authoritative groups don't listen, we have to ultimately lay out too much evidence for them to dismiss, and spread it around so consumers vote with their pocketbooks. It's at that point ineffectual experts will start to change.
Next time you're poo-pooed by a nutrition "authority" about your pursuit of extra protein, print off as much as you can of the studies in this article's reference list and tell them more data is finally on the way.
Then politely ask them three things:
1. "Have you participated in protein research before?"
2. "What's population-specificity?"
3. "What's evidence-based practice?"
Although I doubt they'll change their opinions for a few years yet, at least you'll have let them know you're aware of protein's inconvenient truth.
About the Author
Dr. Lonnie Lowery is an Exercise Physiologist, Nutrition professor of six years, and consumer advocate whose current data collection might bring some light to the persistent controversies surrounding dietary protein specific to strength athletes. He can be reached at Lonman7@hotmail.com, and at IronRadio.org, a new interactive audio site for strength athletes. (Live episodes with Q&A are recorded Friday afternoons.)
References and Further Reading
1. Brandle E, Sieberth HG, Hautmann RE: Effect of chronic dietary protein intake on the renal function in healthy subjects. Eur J Clin Nutr 1996, 50(11):734-40.
2. Campbell B, Kreider RB, Ziegenfuss T, La Bounty P, Roberts M, Burke D, Landis J, Lopez H, Antonio J: International Society of Sports Nutrition Position Stand: Protein and Exercise. J Int Soc Sports Nutr 2007, Sep 26;4:8.
3. Dawson-Hughes B, Harris SS, Rasmussen HM, Dallal GE: Comparative effects of oral aromatic and branched-chain amino acids on urine calcium excretion in humans. Osteoporos Int 2007, 18(7):955-61.
4. Dawson-Hughes B, Harris SS, Rasmussen H, Song L, Dallal GE: Effect of dietary protein supplements on calcium excretion in healthy older men and women. J Clin Endocrinol Metab2004, 89(3):1169-73.
5. Devia L, Huffman J, Mihevic J, Huszti A, Lowery, L: Dietary Protein, Resistance Training and Health: A Call for Evidence [abstract]. International Society of Sports Nutrition National Conference, 2008, Las Vegas NV.
6. Gore, A. An inconvenient truth. Hollywood, CA: Paramount Pictures, 2007.
7. Heaney RP, Layman DK: Amount and type of protein influences bone health. Am J Clin Nutr2008, 87(5):1567S-1570S
8. Hu FB: Protein, body weight, and cardiovascular health. Am J Clin Nutr 2005, 82(1 Suppl):242S-247S.
9. Institute of Medicine: The Role of Protein and Amino Acids in Sustaining and Enhancing Performance. 1999, National Academy Press.
10. Johnson DW. Dietary protein restriction as a treatment for slowing chronic kidney disease progression: the case against. Nephrology (Carlton). 2006 Feb;11(1):58-62.
11. Krieger JW, Sitren HS, Daniels MJ, Langkamp-Henken B. Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression. Am J Clin Nutr. 2006 Feb;83(2):260-74.
12. Lasker DA, Evans EM, Layman DK. Moderate carbohydrate, moderate protein weight loss diet reduces cardiovascular disease risk compared to high carbohydrate, low protein diet in obese adults: A randomized clinical trial. Nutr Metab (Lond). 2008 Nov 7;5:30.
13. Layman DK, Evans EM, Erickson D, Seyler J, Weber J, Bagshaw D, Griel A, Psota T, Kris-Etherton P. A Moderate-Protein Diet Produces Sustained Weight Loss and Long-Term Changes in Body Composition and Blood Lipids in Obese Adults. J Nutr. 2009 Jan 21. [Epub ahead of print]
14. Layman DK, Clifton P, Gannon MC, Krauss RM, Nuttall FQ. Protein in optimal health: heart disease and type 2 diabetes. Am J Clin Nutr. 2008 May;87(5):1571S-1575S. Review.
15. Lemon PW: Protein and amino acid needs of the strength athlete. Int J Sport Nutr. 1991 Jun;1(2):127-45.
16. Lowery LM, Devia L. Dietary protein safety and resistance exercise: what do we really know? J Int Soc Sports Nutr. 2009 Jan 12;6:3.
17. Lowery L, Forsythe C: Protein and Overtraining: Potential Applications for Free-Living Athletes. J Int Soc Sports Nutr 2006, 3(1): 42-50.
18. Martin WF, Armstrong LE, Rodriguez NR. Dietary protein intake and renal function. Nutr Metab (Lond). 2005 Sep 20;2:25.
19. Miracle A, Rane P, Lowery L: Dietary Protein Affects Individual Differences In Enzyme Activity Following Damaging Exercise In Humans. Oh J Sci (Med Biol) [abstract] 2002, 102(1): 7.
20. Moore DR, Robinson MJ, Fry JL, Tang JE, Glover EI, Wilkinson SB, Prior T, Tarnopolsky MA, Phillips SM. Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. Am J Clin Nutr. 2009 Jan;89(1):161-8. Epub 2008 Dec 3.
21. Mullins NM, Sinning WE. Effects of resistance training and protein supplementation on bone turnover in young adult women. Nutr Metab (Lond). 2005 Aug 17;2:19.
22. National Collegiate Athletics Association: Bylaw 16.5.2.2. 2000.
23. Pan Y, Guo LL, Jin HM. Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2008 Sep;88(3):660-6.
24. Pasini E, Aquilani R, Dioguardi FS, D'Antona G, Gheorghiade M, Taegtmeyer H: Hypercatabolic syndrome: molecular basis and effects of nutritional supplements with amino acids. Am J Cardiol. 2008 Jun 2;101(11A):11E-15E.
25. Poortmans JR, Dellalieux O. Do regular high protein diets have potential health risks on kidney function in athletes? Int J Sport Nutr Exerc Metab 2000, 10(1):28-38.
26. Poortmans JR: Exercise and renal function. Sports Med 1984, 1(2):125-53.
27. Shils, M. et al.: Modern Nutrition in Health and Disease. New York, NY: Lippincott Williams & Wilkins; 9th ed. 1999.
28. Smit E, Nieto FJ, Crespo CJ, Mitchell P: Estimates of animal and plant protein intake in US adults: results from the Third National Health and Nutrition Examination Survey, 1988-1991. J Am Diet Assoc 1999, 99(7):813-20.
29. Solerte SB, Gazzaruso C, Bonacasa R, Rondanelli M, Zamboni M, Basso C, Locatelli E, Schifino N, Giustina A, Fioravanti M.: Nutritional supplements with oral amino acid mixtures increases whole-body lean mass and insulin sensitivity in elderly subjects with sarcopenia. Am J Cardiol. 2008 Jun 2;101(11A):69E-77E.
30. Specker B, Vukovich M: Evidence for an interaction between exercise and nutrition for improved bone health during growth. Med Sport Sci. 2007;51:50-63
31. Thorpe MP, Jacobson EH, Layman DK, He X, Kris-Etherton PM, Evans EM. A diet high in protein, dairy, and calcium attenuates bone loss over twelve months of weight loss and maintenance relative to a conventional high-carbohydrate diet in adults. J Nutr. 2008 Jun;138(6):1096-100.
32. Turner CH, Robling AG: Mechanisms by which exercise improves bone strength. J Bone Miner Metab. 2005;23 Suppl:16-22.
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