Low-protein diet

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A low-protein diet is a diet in which people decrease their intake of protein. A low-protein diet is used as a therapy for inherited metabolic disorders, such as phenylketonuria and homocystinuria, and can also be used to treat kidney or liver disease. Low protein consumption appears to reduce the risk of bone breakage, presumably through changes in calcium homeostasis. [1] Consequently, there is no uniform definition of what constitutes low-protein, because the amount and composition of protein for an individual with phenylketonuria would differ substantially from one with homocystinuria or tyrosinemia. [2]

Contents

History

By studying the composition of food in the local population in Germany, Carl von Voit established a standard of 118 grams of protein per day. Russell Henry Chittenden showed that less than half that amount was needed to maintain good health. [3]

Protein requirement

The daily requirement for humans to remain in nitrogen balance is relatively small. The median human adult requirement for good quality protein is approximately 0.65 gram per kilogram body weight per day and the 97.5 percentile is 0.83 grams per kilogram body weight per day. [4] Children require more protein, depending on the growth phase. A 70 kg adult human who was in the middle of the range would require approximately 45 grams of protein per day to be in nitrogen balance. This would represent less than 10% of kilocalories in a notional 2,200 kilocalorie ration. William Cumming Rose and his team studied the essential amino acids, helping to define minimum amounts needed for normal health. For adults, the recommended minimum amounts of each essential amino acid varies from 4 to 39 milligrams per kilogram of body weight per day. To be of good quality, protein only needs to come from a wide variety of foods; there is neither a need to mix animal and plant food together nor a need to complement specific plant foods, such as rice and beans. [5] The notion that such specific combinations of plant protein need to be made to give good quality protein stems from the book Diet for a Small Planet . Plant protein is often described as incomplete, suggesting that they lack one or more of the essential amino acids. Apart from rare examples, such as Taro, [5] [6] each plant provides an amount of all the essential amino acids. However, the relative abundance of the essential amino acids is more variable in plants than that found in animals, which tend to be very similar in essential amino acid abundance, and this has led to the misconception that plant proteins are deficient in some way.

Low-protein vs calorie restriction

Calorie restriction has been demonstrated to increase the life span and decrease the age-associated morbidity of many experimental animals. Increases in longevity or reductions in age-associated morbidity have also been shown for model systems where protein or specific amino acids have been reduced. In particular, experiments in model systems in rats, mice, and Drosophila fruit flies have shown increases in life-span with reduced protein intake comparable to that for calorie restriction. [7] [8] Restriction of the amino acid methionine, which is required to initiate protein synthesis, is sufficient to extend lifespan. [9] [10] [11] Restriction of the branched-chain amino acids is sufficient to extend the lifespan of Drosophila fruit flies and male mice. [12] [8]

Some of the most dramatic effects of calorie restriction are on metabolic health, promoting leanness, decreasing blood sugar and increasing insulin sensitivity. [13] Low-protein diets mimic many of the effects of calorie restriction but may engage different metabolic mechanisms. [14] Low protein diets rapidly reduce fat and restores normal insulin sensitivity to diet-induced obese mice. [15] Specifically restricting consumption of the three branched-chain amino acids leucine, isoleucine and valine is sufficient to promote leanness and improve regulation of blood glucose. [16] A recent randomized-controlled clinical trial showed that protein restriction (PR) improves multiple markers of metabolic health, such as reducing adiposity and improving insulin sensitivity. [17]

The diets of humans living in some of the Blue Zones, regions of enhanced numbers of centenarians and reduced age-associated morbidity, contain less than 10% of energy from protein, [18] although reports on all the Blue Zones are not available. None of the diets in these regions is completely based on plants, but plants form the bulk of the food eaten. [19] Although it has been speculated that some of these populations are under calorie restriction, this is contentious as their smaller size is consistent with the lower food consumption. [20]

Low-protein and liver disease

In the past a standard dietary treatment for those with liver disease or damage was a low protein, high carbohydrate, moderate fat and low salt diet. In addition, vitamin supplements especially vitamin B group should be taken. Sodium might have to be restricted to 500–1,500 mg per day. [21] [22]

Low-protein and kidney disease

Low-protein diets to treat kidney disease include the rice diet, which was started by Walter Kempner at Duke University in 1939. This diet was a daily ration of 2,000 calories consisting of moderate amounts of boiled rice, sucrose and dextrose, and a restricted range of fruit, supplemented with vitamins. Sodium and chloride were restricted to 150 mg and 200 mg respectively. It showed remarkable effects on control of edema and hypertension. [23] [24] Although the rice diet was designed to treat kidney and vascular disease, the large weight loss associated with the diet led to a vogue in its use for weight loss which lasted for more than 70 years. The rice diet program closed in 2013. [25]

Low-protein and osteoporosis

The effect of protein on osteoporosis and risk of bone fracture is complex. Calcium loss from bone occurs at protein intake below requirement when individuals are in negative protein balance, suggesting that too little protein is dangerous for bone health. [26] IGF-1, which contributes to muscle growth, also contributes to bone growth, and IGF-1 is modulated by protein intake. [27]

However, at high protein levels, a net loss of calcium may occur through the urine in neutralizing the acid formed from the deamination and subsequent metabolism of methionine and cysteine. Large prospective cohort studies have shown a slight increase in risk of bone fracture when the quintile of highest protein consumption is compared to the quintile of lowest protein consumption. [1] In these studies, the trend is also seen for animal protein but not plant protein, but the individuals differ substantially in animal protein intake and very little in plant protein intake. As protein consumption increases, calcium uptake from the gut is enhanced. [1] [26] Normal increases in calcium uptake occur with increased protein in the range 0.8 grams to 1.5 grams of protein per kilogram body weight per day. However, calcium uptake from the gut does not compensate for calcium loss in the urine at protein consumption of 2 grams of protein per kilogram of body weight. Calcium is not the only ion that neutralizes the sulphate from protein metabolism, and overall buffering and renal acid load also includes anions such as bicarbonate, organic ions, phosphorus and chloride as well as cations such as ammonium, titrateable acid, magnesium, potassium and sodium. [28]

The study of potential renal acid load (PRAL) suggests that increased consumption of fruits, vegetables and cooked legumes increases the ability of the body to buffer acid from protein metabolism, because they contribute to a base forming potential in the body due to their relative concentrations of proteins and ions. However, not all plant material is base forming, for example, nuts, grains and grain products add to the acid load. [26] [28] [29]

See also

Related Research Articles

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In nutrition, biology, and chemistry, fat usually means any ester of fatty acids, or a mixture of such compounds, most commonly those that occur in living beings or in food.

<span class="mw-page-title-main">Isoleucine</span> Chemical compound

Isoleucine (symbol Ile or I) is an α-amino acid that is used in the biosynthesis of proteins. It contains an α-amino group (which is in the protonated −NH+3 form under biological conditions), an α-carboxylic acid group (which is in the deprotonated −COO− form under biological conditions), and a hydrocarbon side chain with a branch (a central carbon atom bound to three other carbon atoms). It is classified as a non-polar, uncharged (at physiological pH), branched-chain, aliphatic amino acid. It is essential in humans, meaning the body cannot synthesize it. Essential amino acids are necessary in the human diet. In plants isoleucine can be synthesized from threonine and methionine. In plants and bacteria, isoleucine is synthesized from pyruvate employing leucine biosynthesis enzymes. It is encoded by the codons AUU, AUC, and AUA.

Valine (symbol Val or V) is an α-amino acid that is used in the biosynthesis of proteins. It contains an α-amino group (which is in the protonated −NH3+ form under biological conditions), an α-carboxylic acid group (which is in the deprotonated −COO− form under biological conditions), and a side chain isopropyl group, making it a non-polar aliphatic amino acid. It is essential in humans, meaning the body cannot synthesize it: it must be obtained from the diet. Human dietary sources are foods that contain protein, such as meats, dairy products, soy products, beans and legumes. It is encoded by all codons starting with GU (GUU, GUC, GUA, and GUG).

<span class="mw-page-title-main">Dietary fiber</span> Portion of plant-derived food that cannot be completely digested

Dietary fiber or roughage is the portion of plant-derived food that cannot be completely broken down by human digestive enzymes. Dietary fibers are diverse in chemical composition, and can be grouped generally by their solubility, viscosity, and fermentability, which affect how fibers are processed in the body. Dietary fiber has two main components: soluble fiber and insoluble fiber, which are components of plant-based foods, such as legumes, whole grains and cereals, vegetables, fruits, and nuts or seeds. A diet high in regular fiber consumption is generally associated with supporting health and lowering the risk of several diseases. Dietary fiber consists of non-starch polysaccharides and other plant components such as cellulose, resistant starch, resistant dextrins, inulin, lignins, chitins, pectins, beta-glucans, and oligosaccharides.

A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excreted by cells to create non-cellular structures, such as hair, scales, feathers, or exoskeletons. Some nutrients can be metabolically converted to smaller molecules in the process of releasing energy, such as for carbohydrates, lipids, proteins, and fermentation products, leading to end-products of water and carbon dioxide. All organisms require water. Essential nutrients for animals are the energy sources, some of the amino acids that are combined to create proteins, a subset of fatty acids, vitamins and certain minerals. Plants require more diverse minerals absorbed through roots, plus carbon dioxide and oxygen absorbed through leaves. Fungi live on dead or living organic matter and meet nutrient needs from their host.

<span class="mw-page-title-main">Human nutrition</span> Provision of essential nutrients necessary to support human life and health

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An essential amino acid, or indispensable amino acid, is an amino acid that cannot be synthesized from scratch by the organism fast enough to supply its demand, and must therefore come from the diet. Of the 21 amino acids common to all life forms, the nine amino acids humans cannot synthesize are valine, isoleucine, leucine, methionine, phenylalanine, tryptophan, threonine, histidine, and lysine.

<span class="mw-page-title-main">Dietary supplement</span> Product providing additional nutrients

A dietary supplement is a manufactured product intended to supplement a person's diet by taking a pill, capsule, tablet, powder, or liquid. A supplement can provide nutrients either extracted from food sources, or that are synthetic. The classes of nutrient compounds in supplements include vitamins, minerals, fiber, fatty acids, and amino acids. Dietary supplements can also contain substances that have not been confirmed as being essential to life, and so are not nutrients per se, but are marketed as having a beneficial biological effect, such as plant pigments or polyphenols. Animals can also be a source of supplement ingredients, such as collagen from chickens or fish for example. These are also sold individually and in combination, and may be combined with nutrient ingredients. The European Commission has also established harmonized rules to help insure that food supplements are safe and appropriately labeled.

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Calorie restriction is a dietary regimen that reduces the energy intake from foods and beverages without incurring malnutrition. The possible effect of calorie restriction on body weight management, longevity, and aging-associated diseases has been an active area of research.

<span class="mw-page-title-main">Healthy diet</span> Type of diet

A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.

<span class="mw-page-title-main">Branched-chain amino acid</span> Amino acid with a branched carbon chain

A branched-chain amino acid (BCAA) is an amino acid having an aliphatic side-chain with a branch. Among the proteinogenic amino acids, there are three BCAAs: leucine, isoleucine, and valine. Non-proteinogenic BCAAs include 2-aminoisobutyric acid and alloisoleucine.

<span class="mw-page-title-main">Protein (nutrient)</span> Nutrient for the human body

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<span class="mw-page-title-main">Low-fat diet</span> Diet that contains limited amounts of fat

A low-fat diet is one that restricts fat, and often saturated fat and cholesterol as well. Low-fat diets are intended to reduce the occurrence of conditions such as heart disease and obesity. For weight loss, they perform similarly to a low-carbohydrate diet, since macronutrient composition does not determine weight loss success. Fat provides nine calories per gram while carbohydrates and protein each provide four calories per gram. The Institute of Medicine recommends limiting fat intake to 35% of total calories to control saturated fat intake.

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<span class="mw-page-title-main">Weight management</span> Techniques for maintaining body weight

Weight management refers to behaviors, techniques, and physiological processes that contribute to a person's ability to attain and maintain a healthy weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. Moreover, weight management involves developing meaningful ways to track weight over time and to identify ideal body weights for different individuals.

The human skeletal system is a complex organ in constant equilibrium with the rest of the body. In addition to support and structure of the body, bone is the major reservoir for many minerals and compounds essential for maintaining a healthy pH balance. The deterioration of the body with age renders the elderly particularly susceptible to and affected by poor bone health. Illnesses like osteoporosis, characterized by weakening of the bone's structural matrix, increases the risk of hip-fractures and other life-changing secondary symptoms. In 2010, over 258,000 people aged 65 and older were admitted to the hospital for hip fractures. Incidence of hip fractures is expected to rise by 12% in America, with a projected 289,000 admissions in the year 2030. Other sources estimate up to 1.5 million Americans will have an osteoporotic-related fracture each year. The cost of treating these people is also enormous, in 1991 Medicare spent an estimated $2.9 billion for treatment and out-patient care of hip fractures, this number can only be expected to rise.

<span class="mw-page-title-main">Vegetarian and vegan dog diet</span> Adequate meat-free or animal-free nutrition

As in the human practice of veganism, vegan dog foods are those formulated with the exclusion of ingredients that contain or were processed with any part of an animal, or any animal byproduct. Vegan dog food may incorporate the use of fruits, vegetables, cereals, legumes including soya, nuts, vegetable oils, as well as any other non-animal based foods.

References

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