Is Protein in Keto important?

Protein is an essential macronutrient and comes from the greek word Proteos meaning The Most Important one. Protein is everything your body is made from, from your hair, bones, organs, skin; even peptide hormones are made out of protein.

Many people believe that a ketogenic diet is a high-protein diet. This is a myth, a ketogenic diet balances a moderate level of protein with lowered carbohydrates and is high in healthy fats.

Many people also believe that excess protein just turns into sugar in the body. This is also a myth, as it is very dependent on context. We see people throwing around the word HIGH protein around stocking fear in others, without even defining what HIGH protein is:

This leads to many questions:

What is the ideal protein intake? How much is too low protein? Does the amount of protein I eat in one meal matter? Why is too much protein dangerous?

In order to answer these frequently asked questions it is important to be aware of the variation in dietary protein intake, even the differing views discussed amongst the expects in the known community.

I belive in order to establish optimal values in protein intake we need to take into account many seemly  differing expert opinions, to build a complete clearer picture on what optimal protein levels are.

I want to bring to the table 9 experts known within the health community, to weigh in on the discussion of protein:

Dr Jason Fung /  Dr Stephen Phinney / Dr Ron Rosedale / Dr Donald Layman / Dr. Layne Norton

Dr. Robert Heaney / Menno Henselmans / Dr Réjeanne Gougeon / Dr Richard Bernstein

 

Dr Jason Fung on Nitrogen Balance

Dr. Jason Fung is a nephrologist (kidney specialist) and Program Medical Director at Intensive Dietary Management and practices at Scarborough General Hospital at Ontario, Canada.

During October 2016 Jason teamed up with Jimmy Moore to write The Complete  Guide to Fasting which captures Jason’s extensive thoughts on fasting from the blog along with Jimmy’s n=1 experiences.

Controversy arose in the LCHF and Keto community in regards to the lower/higher levels of protein, so Dr Fung wrote an extensive blog post on his intensive dietary management website called, How much protein is excessive?

Dr Fung’s protein recommendations are built around the the minimal RDI levels of Nitrogen balance without loss of lean mass, and states the following:

“In 1985, the WHO reviewed studies of daily obligatory losses of nitrogen, and found that an average is 0.61 g/kg/day (total). Presumable, the diet should replace (roughly) this 0.61 g/kg/day being lost. Remember, this average is for normal healthy people, not people losing muscle or otherwise sick. So the international group recommended that normal healthy people should get roughly 0.6g/kg/day. In order to make sure everybody was covered, the WHO added 25% (2 standard deviations) above the mean to get 0.75 g/kg/day which sometimes gets rounded up to 0.8 g/kg/day. In other words, 97.5% of the healthy general population loses less than this 0.75 g/kg/day of amino acids. This is not a low standard. This is a very, very high standard of protein intake.” – Dr Fung

Why do we look at Nitrogen as important? The main reason why medical professionals talk about it, is it’s an excellent laboratory tracker to measure protein loss from the body. This is because compared to the other macronutrients (protein, carbohydrates and fats) which contain a carbon, hydrogen and oxygen molecule, protein is the only macronutrient that also contains an additional nitrogen molecule.  By getting people to study and carefully counting all the nitrogen content of foods and comparing it to the amount of nitrogen balance they find three different results:

Positive Nitrogen Balance: Nitrogen intake is greater than nitrogen output. Essentially, this is the body’s anabolic (build) state.

Negative Nitrogen Balance: If your nitrogen loss is greater than your nitrogen intake. Not only is nitrogen drawn away from muscle, where it is needed for growth, it is also taken from the vital organs where serious damage can occur. Of course, negative nitrogen balance also destroys muscle and is consequently considered a catabolic state.

Equilibrium: This is the the state you want at a very minimum – where nitrogen intake and loss are equal. In this state you won’t be able to build muscle but you also will not be in a catabolic state.

Then taking the protein levels from Dr Fung’s blog, we get his following protein recommendations, and catchphrases, from his clinical experience:

 

Dr Stephen Phinney on optimum therapeutic window

Dr. Stephen D. Phinney is a Professor of Medicine Emeritus at UC-Davis. He is on the editorial board of the American Journal of Clinical Nutrition.

 

He has twenty-five years of clinical experience as a director of multidisciplinary weight management programs and has contributed to books and peer reviewed articles and is an expert in low carb nutrition and metabolism, fatty acids, inflammation, and the metabolic syndrome.

He is now devoting his time to Virta Health, formed by scientists on a mission to cure the most complex chronic diseases, operating in downtown San Francisco.

According to Dr Steve Phinney’s chart below, a “Well formulated ketogenic diet” (WFKD) contains between 3 and 20% carbohydrates and between 10 and 30% protein.

 

In regards to defining optimal protein levels in a ketogenic diet,  Dr Phinney says in the Nutrition & Metabolism:

“The third dietary factor potentially affecting physical performance is adjusting protein intake to bring it within the optimum therapeutic window for human metabolism. The studies noted herein [13, 14, 15, 20] demonstrate effective preservation of lean body mass and physical performance when protein is in the range of 1.2 – 1.7 g/kg reference body weight daily, provided in the context of adequate minerals. Picking the mid-range value of 1.5 g/kg-d, for adults with reference weights ranging from 60–80 kg, this translates into total daily protein intakes 90 to 120 g/d. This number is also consistent with the protein intake reported in the Bellevue study [9]. When expressed in the context of total daily energy expenditures of 2000–3000 kcal/d, about 15% of one’s daily energy expenditure (or intake if the diet is eucaloric) needs to be provided as protein.”

For performance it was found that if the protein was too low then “The effects of reducing daily protein intake to below 1.2 g/kg reference weight during a ketogenic diet include progressive loss of functional lean tissue and thus loss of physical performance, as demonstrated by Davis et al [21]. In this study, subjects given protein at 1.1 g/kg-d experienced a significant reduction in VO2max over a 3 month period on a ketogenic diet, whereas subjects given 1.5 g/kg-d maintained VO2max.”

Yet if protein was increased too high issues are also seen “At the other end of the spectrum, higher protein intakes have the potential for negative side-effects if intake of this nutrient exceeds 25% of daily energy expenditure. One concern with higher levels of protein intake is the suppression of ketogenesis relative to an equicaloric amount of fat (assuming that ketones are a beneficial adaptation to whole body fuel homeostasis). In addition, Stefansson describes a malady known by the Inuit as rabbit malaise [8]. This problem would occur in the early spring when very lean rabbits were the only available game, when people might be tempted to eat too much protein in the absence of an alternative source of dietary fat. The symptoms were reported to occur within a week, and included headache and lassitude. Such symptoms are not uncommon among people who casually undertake a “low carbohydrate, high protein” diet.”

To close on protein intake on a ketogenic diet, Dr Phinney says “Too little or too much protein can be problematic in the keto-adapted state. Rather than consume large portions of meats or other protein foods, focus on small to moderate protein portions and combine them with generous portions of good sources of fat (e.g., sauces, butter, olive oil)”

 

Dr Ron Rosedale on mTor and Anti-aging

Ron Rosedale M.D. is a medical professional, specializing in nutritional and metabolic medicine whose key areas of work are diabetes and diet. He is also the author of book the Rosedale Diet. He is an alumnus of Northwestern University School of Medicine, 1977. He is based in Denver, Colorado

Many in the health community regard Dr Rosedale as an anti-aging expert and was one of the first to draw attention the importance of insulin in 1995. He is now focusing on the protein effect on mTOR in connection with insulin and aging.

Dr Rosedale protein recommendations are clinically focused on mTOR/insulin on diabetes and aging.

He highlights “One of the primary problems with excess protein or amino acids is that it stimulates mTOR, which stimulates growth rather than regeneration.  Fat calories did not stimulate mTOR, leptin or insulin. They were essentially metabolically free calories.”

 

Rosedale found a diet high in healthy fats that worked quite well for diabetes and heart disease patients. Over time, he discovered that restricting protein was another important factor that could affect health, and even more specifically, the aging process.

So bundling his clinical experience while also considering the prospect of longevity Dr Rosedale says “For people, I’ll put on .7 or .75 grams per kilogram of lean body mass. But if I’ve got a diabetic, and I really want to reverse their aging, which means reverse their diabetes, because diabetesis a model of aging, I’ll put them down to 0.5 or 0.6 grams per kilogram of lean body mass per day.”

In 2016, Rosedale feels that cutting down to 0.75 grams per kilo of lean body mass may actually be a more ideal amount for everyone, and also says you could even go below that because your body will conserve protein when you suppress mTOR and increase maintenance and repair. [YoutTube]

In the past Dr Dr Rosedale said that “on average, you want to have approximately one gram of protein for every kilogram of lean body mass (that is, the weight of your body minus the fat – we all have some fat). The easiest way to calculate your daily protein requirement is to take your ideal weight in kilograms (that is, what you would like to weigh if you could weigh anything) and have roughly one gram of protein per kilogram, minus 10%.“

Then taking the protein levels from Dr Rosedale we get his follow protein recommendations, the higher ends are from his previous recommendations:

 

Dr. Layne Norton and Dr Donald Layman’s on Protein Load

Dr. Donald Layman, a former nutrition professor and research scientist at the University of Illinois has been specifically researching the effects of dietary protein on human health for three decades. His laboratory is working to define protein and amino acid requirements and the interrelationship between dietary protein and carbohydrates in adult health. Their research is focused on the impact of diet and exercise on adult health problems of obesity, Type 2 Diabetes and the Metabolic Syndrome.

Dr. Layne Norton, was one of the first researchers to understand the importance of the mTOR pathway of tissue growth and natural, supplement-based ways to manipulate it. He complete his Bachelor of Science in in Biochemistry from Eckerd College with honors (>3.5 GPA) in 2004 and passed his PhD Nutritional Sciences with honors (>3.5 GPA), at the University of Illinois in 2010.

In regards to what optimal protein is Dr Norton says “The Current RDA is 0.8g/kg for protein intake. Current recommendations are based on minimum needs to achieve short-term nitrogen balance, often do not control for protein distribution, protein source, and are often not applicable to meal feeding. Empirical evidence suggests many trainers and coaches frequently recommend amounts that are 2-4g/kg or even greater.”

Rather than focusing on short-term nitrogen balance he asks “How do we define optimal protein intakes to maximize muscle mass?”

And says in order to define optimal intake we need to look at the following two variables:

  1. Determine optimal protein intake at individual meals to maximize protein synthesis (MPS)
  2. Determine optimal frequency of meal intake

This way Dr Norton says “These variables will dictate total protein intake, and specific meal recommendations are likely more beneficial than daily recommendations as muscle protein synthesis is regulated from meal to meal, not day to day.”

 

Optimal protein intake at individual meals to maximize protein synthesis (MPS)

Leucine (leu) has been shown to stimulate protein synthesis and translation initiation to the same extent as a complete meal and is likely the major amino acid responsible for the anabolic effects of a meal (pubmed).

By comparing a study done from Padden-Jones (study) and Tipton (study) Dr Norton says “it is likely the 3-4g leucine (~0.045-0.06 g/kg) will maximize MPS at a meal in adults.”

Dr Norton points out that understanding lucine regulation is important for working out the amount of protein required and says: “In order to start answering this question of optimal protein intake at a meal we first must make clear as to what defines a “maximum level of benefit” from protein intake. To find the optimal level of protein intake at a meal we must determine what the optimal level of protein at a meal for stimulating muscle protein synthesis is.  It appears that maximizing skeletal muscle protein synthesis requires approximately  ~15g of an essential amino acids. It has been postulated that the amino acid leucine is responsible for the stimulatory effect of dietary protein on protein synthesis and 15g of essential amino acids would contain 3.2g of leucine.  Thus in order to determine how much protein from a specific source is required to elicit the maximal response it may be useful to back calculate how much leucine is contained in the source.  One could then determine how much of the source must be consumed in order to reach the leucine threshold. It is important to note that most of these studies were done on individuals who weighed approximately 155-165 lbs on average.  So if you weigh less than this you might want to aim for the lower end of the threshold whereas if you weigh more you may want to aim for the higher end of the threshold.”

Leucine threshold uptake From Nutrition Forum – Dr. Donald Layman, PhD [YouTube]

 

Examples of the amount of food source required to hit the 3-4g of Leucine in a meal:

Determining optimal frequency of meal intake

In regards to the protein load and meal timing Dr Norton says “Our lab has recently shown that the duration of protein synthesis in response to a complete meal containing protein, carbohydrates, and fats is approximately 3 hours long(link) but plasma amino acid levels were still elevated above baseline and plasma leucine was elevated almost 3x above baseline. It is unlikely that eating another meal 2-3 hours after the first meal would be sufficient to induce another rise in protein synthesis since amino acid/leucine levels are already elevated anyway.  It may therefore be more useful to consume larger amounts of protein at a meal and wait longer between protein doses than the typical 2-3 hours that is typically recommended in the bodybuilding community. Now I am not in any way shape or form implying that we are better off just consuming one large protein meal per day.  What I am implying is that it is better to consume larger protein doses spaced further apart and maximize protein synthesis, rather than consume smaller doses of protein throughout the day, since research has shown that protein synthesis will become refractory to constantly elevated levels of amino acids.  It may be that a period where amino acids return to baseline or near baseline is required in order to initiate another bout of protein synthesis.  I therefore suggest that one [from the bodybuilding community] consume 4-6 larger protein doses per day instead of 6-8 meals and wait 4-5 hours between meals rather than 2-3 hours.”

As we age Dr Norton points out the systems slows down and says:

“As we age however, we become less sensitive to the anabolic effects of amino acids.  Several researchers have shown that comparatively large doses of amino acids are required to maximize the anabolic response in the elderly as opposed to young subjects.  It appears the decreased response in the elderly may be explained by a decrease in the muscle cell content and activity of mTOR and p70S6K, two kinases involved in directing protein synthesis.  In accordance with this research, it has been demonstrated that old subjects require a greater amount of amino acids, specifically leucine, (the amino acid responsible for stimulating protein synthesis) to maximize protein synthesis as opposed to young subjects.  Furthermore, it appears that the decreased anabolic response in the elderly may be due, at least in part, to increased production of reactive oxygen species (ROS) with age.  ROS have been shown to decrease mTOR activity and inhibit protein synthesis.  There is hope however, as it has been demonstrated that supplementing with a combination of antioxidants (rutin, vitamin E, vitamin A, zinc, and selenium) can restore the anabolic effect of a meal to the same level as the young!  So make sure you eat plenty of protein high in leucine (like whey) and keep room in that pill box of yours for some antioxidants grandpa!” [blog]
Finally I asked Dr Laymen why Protein is the most important part of our diet..…

 

 

 

 

 

 

 

This is Dr Nortons average protein recommendations:

 

Dr. Robert Heaney on Bone Mineralization

Dr. Heaney was a clinical endocrinologist specializing in nutrition, wrote a blog showing the level of protein required in order to stimulate bone density growth needs to be greater than 1.2g/kg/d.

Dr Heaney says “This mutual dependence of calcium and protein provides a good illustration of two key (and often underappreciated) aspects of nutrition. The first is that nutrients almost always act together with other nutrients. The second feature is what Bruce Ames of the University of California, Berkeley, has called a “triage” system within nutrition. The body operates a triage mechanism, ensuring that the most vital functions receive the nutrients first and leaving the other tissues and systems of the body to get by on what is left over. It seems that this triage mechanism is at work with respect to adult bone rebuilding.  With limited protein intake, the body ensures that its most vital functions are served first.  Bone, in effect, gets the leftovers.  We need a higher protein intake precisely to ensure that there will be something left for bone.

So, yes, calcium is important.  And protein is important.  But physical work is important, too.  How much Ca? – probably 1500–1800 mg/day.  How much protein? – probably at least 1.2 g/kg body weight/day.  How much exercise?  – probably about what the cardiovascular exercise people recommend, with special emphasis in this instance on impact exercise, such a jumping rope.  Look at toddlers.  Look at the impact forces to which they subject their skeletons.  That’s how they grow bone.”

The figure above shows the 3-year change in bone mineral density (BMD) 

Dr. Heaney passed away August 2016 at the age of 88.

 

 

Menno Henselmans on Protein Upper Limit for Athletes

Menno Henselmans, the director of Bayesian Bodybuilding and a Certified Personal Trainer with the International Sports Sciences Association (ISSA). An Experienced Bodybuilding coach, including several pro card winning clients and international prize winners in physique sports and powerlifting.

Menno wrote an ensive blog post on The Myth of 1 g/lb: Optimal Protein Intake for Bodybuilders in 2012 and goes into great detail how the 2.2g/kg of body weight has become so deeply entrenched in the fitness world that its validity is rarely questioned, so he dived deep into the scientific literature on the effects of daily protein.

Interesting he found that there is an upper limit to how much protein can be utilized to grow muscle:  

 

 

“Based on the sound research, many review papers have concluded 1.8g/kg is the upper limit at which protein intake benefits body composition (Phillips & Van Loon, 2011). This recommendation often includes a double 95% confidence level, meaning they took the highest mean intake at which benefits were still observed and then added two standard deviations to that level to make absolutely sure all possible benefits from additional protein intake are utilized. As such, this is already overdoing it and consuming 2.2g/kg ‘to be safe’ doesn’t make any sense. 1.8g/kg is already very safe”

The picture below summarizes the literature:

As you can see, 1.8g/kg is the point at which additional protein intake ceases to yield any benefits.

Dr. Réjeanne Gougeon on Type 2 Diabetes

Dr. Réjeanne Gougeon is an associate Professor at the

Faculty of Medicine at McGill University in Canada and is Cross-appointed with the School of Dietetics and Human Nutrition at Macdonald Campus in Montreal, Quebec.

Dr Gougeon highlights in a review of 84 studies called Insulin Resistance of Protein Metabolism in Type 2 Diabetes and Impact on Dietary Needs: A Review shows that the metabolism of protein is altered in Type 2 Diabetes Mellitus and insulin resistance not only applies to glucose and lipid but protein metabolism as well.

It’s not an easy task for diabetics to find their goldilocks zone for protein due to this impairments she says “Because high levels of amino acids lower glucose uptake in individuals without diabetes, the challenge remains to define the optimal protein intake and exercise regimen to protect from losses of muscle mass and strength while maintaining adequate glucose control in type 2 diabetes.”

 

Diabetics may be at a larger risk of greater susceptibility to loss of lean tissue as she reported “Compared to non diabetics surveys report greater susceptibility to loss of lean tissue and muscle strength with aging in diabetes. Prevention of sarcopenia requires that protein receives more attention in dietary prescriptions. Protein intake of 1.2 g/kg of body weight (with weight at a body mass index of 25 kg/m2)/day may be distributed equally among 3 meals a day, including breakfast, to optimize anabolism” [Study]

We know that a higher level of protein stimulates more insulin in a diabetic vs a nondiabetic. [study]

Dr Gougeon, also points out that Diabetes may need to ensure they keep this protein load in a meal to an optimal level not to induce this insulin spike “because in older adults it is an adequate protein or leucine content of a meal that regulates the mTOR signalling pathway of muscle protein synthesis and not insulin and energy as in children and young adults. This indicates that to optimize skeletal muscle protein synthesis, particularly in older persons with type 2 diabetes predisposed to sarcopenia, sufficient protein (w30 g) should be provided at every meal, including breakfast.”

To close Dr Gougeon says “Thus protein requirements should only be expressed according to weight or amount of fat-free mass. It is also important to note that protein requirements will be affected by the magnitude of the energy restriction. To optimize skeletal muscle protein synthesis, protein intake should be well distributed over the main three meals of the day, breaking the current tradition of eating little protein at breakfast and the largest proportion at the evening meal. Nutritional strategies that combine exercise before protein ingestion show greater use of amino acids for muscle protein synthesis in insulin-resistant aged men (84). The challenge remains to define individualized prescription of optimal protein intake and exercise regimen to protect from lean tissue and bone losses and decreases in muscle strength and mobility while enhancing glucose control.”

 

Dr Richard Bernstein on Type 1 Diabetes

Dr Richard Bernstein now in his 80’s developed type 1 diabetes when he was 12. If he lived in Australia he would have multiple Kellion Victory Medal Awards, for those who have lived with type 1 or type 2 diabetes for 50 years or more.

He is a physician and an advocate for a low-carbohydrate diet to help achieve normal blood sugars for diabetics.

His private medical practice in Mamaroneck, New York is devoted solely to treating diabetes and prediabetes.

He is a fellow of the American College of Nutrition, the American College of Endocrinology and The College of Certified Wound Specialists. He is the author of six books on diabetes and normalizing blood sugars.
In Dr Bernstein’s book the Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars published in 2011, he notes that protein can stimulate glucose production but is a slow conversion process and highlights that “The liver (and the kidneys and intestines to a lesser extent) can convert protein to glucose, although it’s a slow and inefficient process. Since the conversion process—called gluconeogenesis—is slow and inefficient, diabetics don’t see the high blood sugar spikes they would see from many ingested carbohydrates.”

In his book he has a chapter in regards to why kidney specialists fear moderate levels of protein in their diabetic patients. The main point he states is “Diabetic nephropathy does not appear if blood sugar is kept normal. Dietary protein does not cause diabetic nephropathy, but can possibly (still uncertain) slightly accelerate the process once there has been major, irreversible kidney damage. Dietary protein has no substantial effect upon the GFR of healthy kidneys, certainly not in comparison to the GFR increase caused by elevated blood sugar levels.”

He recommends for people maintaining their sugars to also note meal timing and aim to “keep protein portions in a particular meal consistent day-to-day and recommends at least 1–1.2 g of protein per kilogram of ideal body weight for non-athletic adults.” but this can be variable as “If you have gastroparesis, however, you should limit your evening meal protein to 2 ounces of eggs, cheese, fish, or ground meat, while eating more protein at the two earlier meals in the day.”

Dr. Bernstein says “Protein intake is a personal thing depending on the direction you want to head” [YouTube]

 

Experts Summary

So as we gather all the information involved on HIGH protein and discussing HIGH protein it NEEDS to be in context, many people throw around the word HIGH protein and don’t define the context.

Here is a summary showing all the experts average daily protein recommendations from the information above:

As you can see we are in the suggested safety for protein intake [pubmed] across our experts.

More importantly from all the the information we discussed from the expects we need to take into account all the variables of protein–calorie malnutrition, Nitrogen Balance, Leucine intake, muscle protein synthesis rate, bone mineral density & protein load on rate of protein synthesis.

Balancing out our protein load to take advantage of muscle protein synthesis is important so as to take optimal advantage of our dietary protein, while balancing out periods of autophagy / fasting to clean out old dead protein and improve insulin sensitivity.

Spreading 90g of protein over 3 meals rather than stimulating protein synthesis once.
Paddon-Jones and Rasmussen, Curr Opin Clin Nutr Metab Care, 2009

So you need to take all these variables into account when planning your meals, especially if you suffer from metabolic disorders like metabolic syndrome and diabetes.

My Recommendations

Here are my recommendations for moderating levels protein levels while following a ketogenic diet, for the average person, taking into account all the information discussed. These recommendations are aimed at avoiding lean mass loss, balancing protein evenly across meals and spacing meals far enough to optimize insulin sensitivity and protein absorption, we get the following average table:

Fasting in the Dangerzone

The Danger zone is only utilized when purposefully engaging in fasts. Dr Fung explains the feast-fast-feast model when discussing re-feeds, as when we don’t stimulate mTOR signalling proteins will be striped from the body. Dr Fung illustrates that by clearing the kitchen from “junk proteins” and goes onto say that feeding to rebuild the kitchen with new materials is crucial. [podcast]

Summary

The bottom line on protein is, if we wish to optimize the utilization of protein in our biology, we need to ensure we ingest enough protein in a meal to achieve nitrogen balance, lean mass repair, not over consuming in a meal to avoid issues, for our own biology. By taking these goal into account as a reference, we can ensure long term that we do not break ourselves down, and avoid unnecessary harm.

So the next time someone says we need to avoid HIGH protein, it needs to be understood in context, and clearly defined intake vs load vs frequency vs metabolic state.

I agree from the Greek meaning of Protein, it truly is The Most Important One, to get right first when planning your lifestyle as actively avoiding protein in preference of fat will lead to a poor micro-nutrient balance outcome.

 

 

References

The-word-protein-comes-from-the-greek-proteos [Blog]

Optimising Nutrition Optimal Protein Intake [Blog]

Optimising Nutrition The Complete Guide to Fasting Book Review [Blog]

Jason Fung IDM – How much protein is excessive? [Blog]

The specificity of satiety: the influence of foods of different macronutrient content on the development of satiety. [Study 1988]

Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes for Protein. [2014 PDF]

Gluconeogenesis [wikipedia]

List of 21 Proteinogenic Amino Acids [nutrientsreview]

The Essential Guide to Nutrient Requirements (2006) [PDF]

Under-five Protein Energy Malnutrition Admitted at the University of In Nigeria Teaching Hospital, Enugu: a 10 year retrospective review [10 year nutritional review]

Protein-Energy Malnutrition Definition [PDF]

Nutrition Forum – Dr. Donald Layman, PhD [YouTube]

National Diabetes Statistics Report, 2014 [PDF]

Dietary Guidelines should reflect new understandings about adult protein needs. [Pubmed 2009 Study]

What is Lean Body Mass? [Blog]

Ketogenic Calculator [Blog]

Nitrogen Balance: The Key To Muscle Growth. [Blog]

Layne Norton PhD on protein: how much and how often? [Blog]

The leucine content of a complete meal… [PubMed][Journal of Nut]

Layne Norton PhD [Coaching Service]

Top Seven Fitness and Nutrition Experts [Blog]

Leucine is a critical factor determining protein quantity and quality to initiate muscle protein synthesis [Dr Norton Thesis]

Insulin Resistance of Protein Metabolism in Type 2 Diabetes and Impact on Dietary Needs 2013 [review]

Metabolic response of people with type 2 diabetes to a high protein diet [study]

Richard K. Bernstein [wikipedia]

Dr. Bernstein: Effect of Dietary Protein on Blood Sugar [Blog]

Dr. Bernstein’s Diabetes Solution [book] [Appendix A: Why is Protein Restriction so Common?]

Dr. Ron Rosedale  [Wikipedia]

How and Why Too Much Protein Triggers Aging and Cancer [Blog]

The Rosedale Diet [Book]

The Rosedale Health Plan [Blog official Website]

2014 Dairy Council of California and Society for Nutrition Education and Behavior [PDF]

Dr. Stephen Phinney – ‘Achieving and Maintaining Nutritional Ketosis’ [YouTube]

Optimal Protein Intake And Meal Frequency To Support Maximal Protein Synthesis and Muscle Mass [Layne Norton’s presentation from the 2008 International Society for Sports]

Ketogenic diets and physical performance – Stephen D Phinney [Nutrition & Metabolism]

Anabolic Eating for your Age [Blog]

A review of issues of dietary protein intake in humans.[pubmed]

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