Latest / The Antisocial Doctors Podcast / Episode 11: How Much Protein Do We Really Need?

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Episode 11: How Much Protein Do We Really Need? · The Antisocial Doctors Podcast

• 1:27
  Sonia Singh MD: You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety
• 1:38
  Rebecca Berens MD: and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
• 1:43
  Sonia Singh MD: We're also a millennial women anxious moms and curious humans navigating social media.
• 1:48
  Sonia Singh MD: We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
• 1:56
  Rebecca Berens MD: This podcast is meant to be the antidote to your doom.
• 1:58
  Rebecca Berens MD: Scrolling, a solve for the anxiety, stress, guilt, shame, and confusion.
• 2:02
  Rebecca Berens MD: That comes from social media's messaging around health.
• 2:05
  Rebecca Berens MD: In each episode, we discuss a health related talk trending on social media with curiosity, nuance evidence, humility, and compassion.
• 2:12
  Sonia Singh MD: This is not your average debunking podcast we wanna explore not just what is trending on social media.
• 2:17
  Sonia Singh MD: But why?
• 2:18
  Sonia Singh MD: Why are so many people drawn to this?
• 2:20
  Sonia Singh MD: What is the nugget of truth here?
• 2:21
  Sonia Singh MD: What are the facts?
• 2:23
  Sonia Singh MD: What can we learn from this as patients and doctors?
• 2:25
  Sonia Singh MD: No shame.
• 2:26
  Sonia Singh MD: No blame, no snark.
• 2:27
  Rebecca Berens MD: We're so glad you're here.
• 2:43
  Sonia Singh MD: Hi Rebecca.
• 2:44
  Rebecca Berens MD: Hi Sonia.
• 2:46
  Sonia Singh MD: So today's topic has been one that I feel like I've been wanting to talk about for a long time.
• 2:52
  Sonia Singh MD: And actually as I was researching this topic, I felt like I kept coming across other things that I was like, oh my God, we should talk about this.
• 2:58
  Sonia Singh MD: We should talk about that.
• 2:59
  Sonia Singh MD: And I'm starting to feel this urgency about getting these episodes out.
• 3:03
  Sonia Singh MD: 'cause I see just so much discussion about these things and they feel very, I don't know, topical and just relevant, and so anyway, I'm glad that we're at least starting with this one.
• 3:14
  Rebecca Berens MD: Yeah, no, this is, this one is perfect.
• 3:15
  Rebecca Berens MD: I'm super excited to hear what you found and have this conversation.
• 3:19
  Rebecca Berens MD: 'cause this is a near daily topic of conversation, whether with a patient or with a person that I just know socially.
• 3:26
  Rebecca Berens MD: It's constant.
• 3:27
  Rebecca Berens MD: So I'm really excited to talk about this.
• 3:29
  Sonia Singh MD: Yeah, and actually I'm realizing right now that I don't I don't have a specific patient story for this one, but again, that's because I feel like I get asked about this on a daily basis, so it's impossible to pick one.
• 3:42
  Sonia Singh MD: But a very common experience I have is that a patient will come in and say.
• 3:47
  Sonia Singh MD: My trainer told me I need to be eating 150 grams of protein per day and I can't do it.
• 3:53
  Sonia Singh MD: How do I do it?
• 3:54
  Sonia Singh MD: And so yeah, a common question I get is am I eating enough protein?
• 3:59
  Sonia Singh MD: How much protein should I actually be eating?
• 4:01
  Sonia Singh MD: And I feel like the message that is coming through in the zeitgeist right now is that everybody needs to be eating more protein.
• 4:10
  Sonia Singh MD: I saw a funny meme and it was like I had to quit my full-time job so I could get enough protein.
• 4:15
  Sonia Singh MD: So anyway, it's clearly it's clearly a message we're all getting right now.
• 4:19
  Sonia Singh MD: I'm assuming you've heard the same
• 4:21
  Rebecca Berens MD: Oh, absolutely.
• 4:22
  Rebecca Berens MD: Absolutely.
• 4:22
  Rebecca Berens MD: I think even from our politicians, there's been descriptions of yes.
• 4:26
  Rebecca Berens MD: There's been a war on protein for all of these years and now the protein is coming back.
• 4:30
  Rebecca Berens MD: We were apparently behind, behind the eight ball on protein for all this time.
• 4:33
  Rebecca Berens MD: Yeah.
• 4:34
  Rebecca Berens MD: Let's let's talk
• 4:34
  Sonia Singh MD: about, yeah, let's get into it.
• 4:36
  Sonia Singh MD: Let's talk about that.
• 4:36
  Sonia Singh MD: So what is the claim?
• 4:37
  Sonia Singh MD: What I would distill down from it is just that all of us need to be eating more protein.
• 4:42
  Sonia Singh MD: We're not getting enough protein, and that protein is key to metabolic health, to battling weight gain, to building muscle, and we all just need to be.
• 4:51
  Sonia Singh MD: Prioritizing it more.
• 4:53
  Sonia Singh MD: I'm curious what your thoughts are on why it is so viral and why protein is just having its moment right now.
• 5:01
  Rebecca Berens MD: Yeah, I think it feels like something attainable.
• 5:05
  Rebecca Berens MD: To do.
• 5:05
  Rebecca Berens MD: We've talked about this in other episodes, right?
• 5:07
  Rebecca Berens MD: There's a lot of dietary changes that are really challenging to make.
• 5:11
  Rebecca Berens MD: Yep.
• 5:12
  Rebecca Berens MD: And it seems like something that's attainable and something that people can sell you to fix the problem.
• 5:18
  Rebecca Berens MD: True, oh, we'll add, very viable.
• 5:19
  Rebecca Berens MD: Yeah.
• 5:19
  Rebecca Berens MD: We'll just add protein to all the things that you're already buying and now it's healthy because we added protein to it.
• 5:24
  Rebecca Berens MD: So I think it's both a reaction to a problem that people are experiencing and I'm struggling to get adequate nutrition.
• 5:31
  Rebecca Berens MD: And balanced nutrition in my day.
• 5:33
  Rebecca Berens MD: And so the answer to that is, here's a product with protein added yes.
• 5:37
  Rebecca Berens MD: That you can buy.
• 5:37
  Rebecca Berens MD: And now it's, here's the easy button, right?
• 5:40
  Rebecca Berens MD: This is how you eat healthy, buy this like protein stuffed, whatever it is, and now it's healthy.
• 5:45
  Rebecca Berens MD: So that's where I feel like it's come from.
• 5:47
  Rebecca Berens MD: But I'm curious what you found when you were.
• 5:49
  Rebecca Berens MD: Going through this?
• 5:50
  Sonia Singh MD: Yeah.
• 5:51
  Sonia Singh MD: Okay.
• 5:51
  Sonia Singh MD: So I would start with the same thing that I have started probably all of our, or like I've mentioned in all of our food and nutrition related episodes, which is just that I think nutritional science is just really a confusing area for people, not just for.
• 6:06
  Sonia Singh MD: The lay public, but even in medicine, it's just a messy science and things shift and change.
• 6:11
  Sonia Singh MD: And so sometimes what we thought 20 years ago or three years ago, we don't think anymore.
• 6:16
  Sonia Singh MD: And so I think, we don't get a ton of nutritional education in general education and then, even in medical education and sometimes, it's hard to keep up to date with what is the current thinking around this?
• 6:28
  Sonia Singh MD: And so I think it, I think it's just an area of just a lot of confusion for people.
• 6:33
  Sonia Singh MD: And not only is the knowledge base confusing.
• 6:36
  Sonia Singh MD: But the food environment is also so confusing and so overwhelming.
• 6:39
  Sonia Singh MD: Like the number of products that exist out there is insane.
• 6:44
  Sonia Singh MD: And like you said, the number of products, specifically targeting people, trying to eat more protein.
• 6:48
  Sonia Singh MD: I think the other day I walked into a Starbucks and just started laughing at the menu.
• 6:51
  Sonia Singh MD: 'cause I was like.
• 6:53
  Sonia Singh MD: Protein foam, what on earth?
• 6:54
  Sonia Singh MD: Why are they putting protein powder in all of these things, so yeah, I'm just more and more amazed by like how many bizarre techno products have been created and just how confusing the marketplace can be.
• 7:05
  Sonia Singh MD: So I think that's a big part of it.
• 7:07
  Sonia Singh MD: I think we've lived through the low fat diet era and then we've lived through the low carb era.
• 7:13
  Sonia Singh MD: And protein is like the one macronutrient that has so far not been vilified, but I feel like it, I feel like it's time will come.
• 7:21
  Sonia Singh MD: Protein will Yeah.
• 7:22
  Sonia Singh MD: Eventually be canceled, I'm waiting for it to be canceled.
• 7:25
  Sonia Singh MD: But all the other macronutrients have at some point been canceled and protein.
• 7:29
  Sonia Singh MD: Seems to have this halo, it's like the golden child of the macronutrients, where almost no one will argue with you about eating protein.
• 7:37
  Sonia Singh MD: The other thing that I think is actually relevant for a lot of the topics we're gonna cover in this podcast is just that.
• 7:43
  Sonia Singh MD: The way fitness culture used to be, this very specific sub subculture and now fitness culture has just seeped into the mainstream.
• 7:52
  Sonia Singh MD: Things that I would only hear about from like my patients who were like bodybuilders or per like serious athletes are now trickling down to the general population in a way that I don't think they did before.
• 8:05
  Sonia Singh MD: And so I think that's a really interesting phenomenon.
• 8:08
  Sonia Singh MD: It's 20 years ago, 30 years ago, like it was really just bodybuilders that were talking to me about insane protein requirements in creatine.
• 8:15
  Sonia Singh MD: And now like the suburban moms are talking to me about protein requirements in creatine.
• 8:19
  Sonia Singh MD: So I think there's just overall like a shift in the culture around, food, nutrition, fitness, all of that.
• 8:26
  Sonia Singh MD: I think again, a theme we've seen a few times is that.
• 8:29
  Sonia Singh MD: COVID, like the pandemic put people's mortality and their health in clearer focus.
• 8:34
  Sonia Singh MD: I think a lot more people who had not really prioritized or thought that much about their health were suddenly like.
• 8:40
  Sonia Singh MD: How can I be healthier?
• 8:41
  Sonia Singh MD: How can I live longer?
• 8:42
  Sonia Singh MD: How can I boost my immunity?
• 8:44
  Sonia Singh MD: How can I improve my metabolic health?
• 8:47
  Sonia Singh MD: And so I think there's just, that's part of what's driven this whole excitement around longevity and optimization and all of, all of that stuff I think is born from that reckoning of oh my gosh, we need to get healthy.
• 9:00
  Sonia Singh MD: And then, I think.
• 9:03
  Sonia Singh MD: This is also a consequence of when you live in a society or an environment where there is so much abundance and there's less concern about deficiencies, the focus becomes optimizing everything, convincing you that it's not okay to just have enough and it's not okay to be normal, but you need to have the optimal amount.
• 9:23
  Sonia Singh MD: So I think we see that a lot, which is ironic'cause there's still so many Americans that live with food insecurity.
• 9:28
  Sonia Singh MD: But that's not what's showing up on Instagram.
• 9:31
  Sonia Singh MD: What's showing up on Instagram is somebody who's already very fit, talking about how to optimize your nutrition or your exercise routine for longevity.
• 9:39
  Sonia Singh MD: So
• 9:39
  Rebecca Berens MD: yeah, I think that point I think is huge.
• 9:43
  Rebecca Berens MD: Because that, that's something that, I've talked about this before, be, before coming onto private practice, I was working in mostly low resource settings, like safety net clinics.
• 9:52
  Rebecca Berens MD: And it is crazy how, like you said, there are so many people who still don't have enough.
• 9:57
  Rebecca Berens MD: They just don't have the basics.
• 9:59
  Rebecca Berens MD: But the focus is so much more on the optimization and it is there's this sort of, because we're in a, overall higher resource country, a lot of people have access to everything that they need, and there is, it's a very it's a culture focused on consumption.
• 10:13
  Rebecca Berens MD: And and, getting as much as you can, as much as more and more, more.
• 10:17
  Rebecca Berens MD: And it's crazy how that then trickles down so that people who actually don't have the basics are then following the advice of the people who have everything that they need and more.
• 10:29
  Rebecca Berens MD: And it's making them, it's it's just wor widening that gap even more.
• 10:33
  Rebecca Berens MD: Yeah.
• 10:34
  Rebecca Berens MD: Because If you're, if all you're hearing is about how to optimize, but you don't even have the basics, it's such a different way of thinking and a set of needs.
• 10:41
  Rebecca Berens MD: But it's actually widening that gap that we have societally.
• 10:45
  Sonia Singh MD: I totally agree, and it's it, so not only do the people who don't have the resources then feel this even, bigger discrepancy between what they're supposed to be achieving and where they are.
• 10:55
  Sonia Singh MD: But I actually think even people at the other end of the spectrum who are well-resourced and doing everything right for them, it creates this endless pit of oh, I'm never doing it.
• 11:04
  Sonia Singh MD: It makes everybody feel that they're not doing it, doing well enough, and I, yeah.
• 11:09
  Sonia Singh MD: I have a sweatshirt that says you are enough.
• 11:12
  Sonia Singh MD: And I feel like that is I we are this culture of, like you said, overabundance over consumption, and I think it's just in health, in health and healthcare and wellness.
• 11:21
  Sonia Singh MD: This is where we see that, where it's like nothing is ever enough and there's always like a striving for the next thing and the next thing and the next thing.
• 11:27
  Sonia Singh MD: So anyway.
• 11:29
  Sonia Singh MD: Yeah, we could.
• 11:30
  Sonia Singh MD: I'm sure we could wax poetic about the whole culture of optimization.
• 11:34
  Sonia Singh MD: We should probably do a whole episode on culture of optimization.
• 11:36
  Sonia Singh MD: Yes.
• 11:36
  Rebecca Berens MD: But,
• 11:37
  Sonia Singh MD: Okay.
• 11:37
  Sonia Singh MD: So that's one thing.
• 11:38
  Sonia Singh MD: The other thing that I didn't really have find any research on this.
• 11:41
  Sonia Singh MD: I'm sure there are essays on this topic somewhere, but it occurred to me that, protein is something that we associate with strength and power and Substance and maybe even masculinity, like the way people will say, yeah, okay, but what's the protein of this?
• 11:55
  Sonia Singh MD: What's the protein of this, meeting.
• 11:56
  Sonia Singh MD: And the no other macronutrient is like that.
• 12:00
  Sonia Singh MD: I don't think anybody, thinks about or talks about carbs or fats in that particular kind of way.
• 12:06
  Sonia Singh MD: So again, it has this weird halo, golden child kind of vibe around it, which is kinda interesting to think about.
• 12:13
  Sonia Singh MD: And then lastly, as you mentioned, it's not just tiktoks and Instagram and influencers that are telling us to do this.
• 12:19
  Sonia Singh MD: The US government is telling us to eat more protein.
• 12:23
  Sonia Singh MD: So as of January 7th, 2026, we published the new US dietary guidelines that were released by the HHS and the U-U-S-D-A and they basically increased the recommended.
• 12:34
  Sonia Singh MD: Daily protein intake for Americans from 0.8 grams per kilogram per day to 1.2 to 1.6 grams per kilogram to per day.
• 12:43
  Sonia Singh MD: So that's almost double what the previous recommendation was.
• 12:46
  Sonia Singh MD: So it's not just that it's viral and a hot topic and trending.
• 12:50
  Sonia Singh MD: It's actually been incorporated into the guidelines for, dietary recommendations for Americans.
• 12:56
  Sonia Singh MD: And then a common figure that, I didn't add this to the.
• 12:58
  Sonia Singh MD: Claim, but like a figure that I've heard patients say to me and that I've seen said on social media especially with people who are really into fitness and working with personal trainers, is a gram per pound per day, which is yep, 2.2 grams per kilogram per day.
• 13:12
  Sonia Singh MD: Which is a lot.
• 13:14
  Rebecca Berens MD: Yes.
• 13:14
  Sonia Singh MD: Yeah, I think, and when you're hearing that and your Dr.
• 13:17
  Sonia Singh MD: May be telling you, oh no, you're eating enough, 0.8, I think that creates this huge gap of, who is right?
• 13:24
  Sonia Singh MD: And what is the answer?
• 13:25
  Sonia Singh MD: And also what prompted this sudden change in the dietary guidelines and what are the old ones wrong Is are the new ones wrong?
• 13:31
  Sonia Singh MD: Like what, where is the truth in this?
• 13:33
  Rebecca Berens MD: Yeah.
• 13:34
  Rebecca Berens MD: And I feel like, I'm actually really curious.
• 13:36
  Rebecca Berens MD: I don't know if maybe this will come up later, but I think that comes from eat your body weight and protein I think was a common, guideline that was given, which if you're going grams per kilogram is approximately yes, what we were saying.
• 13:49
  Rebecca Berens MD: But it's just did people just misinterpret eat your body weight in protein because they think in pounds and we're like, oh or did they actually pull that from somewhere?
• 13:57
  Rebecca Berens MD: I'm really curious what, I think it just was literally like I didn't understand the difference between a kilogram and a pound.
• 14:04
  Sonia Singh MD: No, I, yeah, I don't think I wanna give them more credit than that.
• 14:07
  Sonia Singh MD: It's that they just misunderstood pounds and kilograms.
• 14:10
  Sonia Singh MD: I think.
• 14:10
  Sonia Singh MD: I think it's not just a conversion error but whether that number is really based on the best available evidence is pretty debatable.
• 14:17
  Sonia Singh MD: So anyway, let's talk about what is the negative truth here?
• 14:20
  Sonia Singh MD: So I think to talk about.
• 14:22
  Sonia Singh MD: All of this, we need to start with just the foundation about protein generally.
• 14:26
  Sonia Singh MD: So what is protein?
• 14:27
  Sonia Singh MD: It's an important macronutrient.
• 14:29
  Sonia Singh MD: It's important for a zillion functions throughout the body.
• 14:32
  Sonia Singh MD: It's one of your main building blocks.
• 14:34
  Sonia Singh MD: Proteins are made up of amino acids, of which there are 20 some of these.
• 14:38
  Sonia Singh MD: Most of them, your body is actually able to synthesize, but others must be acquired from the diet.
• 14:43
  Sonia Singh MD: Those are called the essential amino acids.
• 14:45
  Sonia Singh MD: And we all think of protein as helping build muscle, but they serve a bunch of different functions, serve as enzymes.
• 14:51
  Sonia Singh MD: They can be hormones, they can be neurotransmitters.
• 14:54
  Sonia Singh MD: Protein has a bunch of different roles beyond just mu muscle building.
• 14:58
  Sonia Singh MD: And there are serious, it's true that there are very serious consequences to not getting enough protein.
• 15:03
  Sonia Singh MD: So if you get down to say 0.4 or 0.5 grams per kilogram.
• 15:08
  Sonia Singh MD: You can start having muscle wasting, impaired muscle function, weakness, impaired immune function.
• 15:15
  Sonia Singh MD: When your protein levels are low, you can't hold fluid in your vessels and you can start developing swelling or edema.
• 15:21
  Sonia Singh MD: In children, inadequate protein can lead to stunted growth.
• 15:24
  Sonia Singh MD: It can impair their brain development.
• 15:26
  Sonia Singh MD: So protein is a very critical, important macronutrient.
• 15:30
  Sonia Singh MD: I don't wanna hate on protein.
• 15:31
  Sonia Singh MD: It is important and a word that I think a lot of people might be hearing right now if they're into health and wellness is sarcopenia.
• 15:38
  Sonia Singh MD: So sarcopenia refers to generalized loss of muscle mass and function which is highly correlated.
• 15:44
  Sonia Singh MD: Physical disability, poor quality of life, frailty, falls, even higher risk of death.
• 15:48
  Sonia Singh MD: And mostly, historically, we've thought about sarcopenia in the context of aging in an elderly population, but now we're hearing more and more about sarcopenia in younger patients who are maybe obese and have had dramatic weight loss with a GLP one or with some other means.
• 16:03
  Sonia Singh MD: And so you hear this about this phenomenon of sarcopenic obesity where somebody may have.
• 16:09
  Sonia Singh MD: A lot of adipose tissue, but they still may be losing muscle mass or have very low muscle mass despite having a larger body.
• 16:15
  Sonia Singh MD: I think this is all very I'm sure people are hearing a lot of these words or hearing a lot of the importance of protein.
• 16:20
  Sonia Singh MD: And I agree that it is extremely important and it's true that we are, that sarcopenia is a major concern and we're seeing more of it.
• 16:27
  Sonia Singh MD: So that's a general kind of intro to protein.
• 16:30
  Sonia Singh MD: Now, there are certain subgroups that are at higher risk for inadequate protein.
• 16:35
  Sonia Singh MD: So I mentioned some of them already.
• 16:36
  Sonia Singh MD: These are the same people that are at risk for sarcopenia, so older adults people with higher protein demands or metabolic demands.
• 16:43
  Sonia Singh MD: So need for more protein.
• 16:44
  Sonia Singh MD: That's like athletes, pregnant women, breastfeeding women, those with obesity who are trying to lose weight, who are at risk for muscle loss.
• 16:51
  Sonia Singh MD: Those going through menopause and have natural changes in their body composition that may lead to muscle mass, loss of muscle mass.
• 16:57
  Sonia Singh MD: So all of those people in those groups would probably benefit from consuming more protein.
• 17:03
  Sonia Singh MD: So when you think about all of those groups that actually, and does cover a large portion of the American population, a ton of people are aging, a ton of people are pregnant or breastfeeding or trying to, or obese and trying to lose weight.
• 17:17
  Sonia Singh MD: It's.
• 17:17
  Sonia Singh MD: It's not shocking to me that people would be concerned about this, and I do think it's a legitimate thing to wanna look into and make sure you're getting, an adequate amount.
• 17:27
  Sonia Singh MD: But I think to really get to the truth on this, you have to really, this is like a classic example of where the context and the nuances of it really make a difference.
• 17:38
  Sonia Singh MD: So first I wanna talk about what are Amer, what are we doing now?
• 17:41
  Sonia Singh MD: Where are we at with this?
• 17:42
  Sonia Singh MD: Because in nutrition school, like when I got my master's, their prevailing wisdom was Americans get enough protein, we just get enough, we just stop talking about protein.
• 17:50
  Sonia Singh MD: 'cause we get enough fiber is where we really need to be talking to people about how they're not getting enough.
• 17:55
  Sonia Singh MD: But protein, we're doing fine on.
• 17:57
  Sonia Singh MD: There's a lot of debate about whether that initial, recommended daily intake of 0.8 was appropriate or whether it was an underestimate.
• 18:06
  Sonia Singh MD: A lot of people critique the studies that was based on for flawed methodology, and they say, oh, those were just done, in a way that really underestimates what people's needs are.
• 18:16
  Sonia Singh MD: And truthfully, I don't feel like I am qualified enough, in those methodologies to really be able to critique that in.
• 18:25
  Sonia Singh MD: Meaningful way from my standpoint.
• 18:27
  Sonia Singh MD: So I'm not even gonna go there.
• 18:29
  Sonia Singh MD: But, I think what we do know is that there, there is quite a bit of data in these certain subgroups that may not be adequate.
• 18:38
  Sonia Singh MD: And I think that's.
• 18:39
  Sonia Singh MD: That's where the real truth of the matter lies.
• 18:41
  Sonia Singh MD: So maybe 0.8 grams per kilogram per day is enough to prevent muscle wasting.
• 18:47
  Sonia Singh MD: But is that enough for somebody trying to build muscle?
• 18:49
  Sonia Singh MD: Is that enough for somebody trying not to lose it?
• 18:51
  Sonia Singh MD: Who is at risk of losing it?
• 18:52
  Sonia Singh MD: Is that enough for somebody with increased demands'cause of their activities or their.
• 18:56
  Sonia Singh MD: Pregnant state or the breastfeeding state or whatever.
• 18:58
  Sonia Singh MD: No.
• 18:59
  Sonia Singh MD: So the amount that Americans are typically consuming is 80 to 90 grams of protein per day, which comes out to 1.1 to 1.3 grams per kilogram per day.
• 19:08
  Sonia Singh MD: And that's based on NHANES data, which is a huge national survey that has gone on for years and years.
• 19:13
  Sonia Singh MD: And that data was between 2001 and 2014.
• 19:16
  Sonia Singh MD: So not, it has not been checked.
• 19:18
  Sonia Singh MD: I don't have the numbers as recently as this protein, current protein craze that we're in, but as of then, we were having 1.1 to 1.3.
• 19:26
  Sonia Singh MD: And as you may recall, I think I said the current recommendations were.
• 19:31
  Sonia Singh MD: 1.2 to 1.6 in the new guidelines?
• 19:33
  Sonia Singh MD: Yeah, so we're actually, for the most part we're doing okay on the protein.
• 19:38
  Sonia Singh MD: We're not all wildly deficient.
• 19:40
  Sonia Singh MD: There are some ages in ethnic groups where people are maybe not getting enough.
• 19:45
  Sonia Singh MD: Very few people were down in the 0.4 to 0.5 grams per kilogram range that's associated with the more severe consequences.
• 19:53
  Sonia Singh MD: The most important subgroup was older adults where the presence of sarcopenia is like 10 to 25%.
• 19:59
  Sonia Singh MD: So there is evidence that those people may not be getting adequate protein, but.
• 20:04
  Sonia Singh MD: Sarcopenia develops not only from inadequate protein, but from inadequate protein and or inadequate activity.
• 20:10
  Sonia Singh MD: Yeah.
• 20:10
  Sonia Singh MD: So it's not just an issue of protein because if you consume more protein but do not do the activity, there's not going to be a dramatic difference in body composition.
• 20:22
  Sonia Singh MD: So I wanted to go through a few of these subgroups and mention what kind of the evidence-based.
• 20:29
  Sonia Singh MD: Recommended amounts of protein would be for those subgroups.
• 20:33
  Sonia Singh MD: And I have references for all of these that are gonna be on the substack.
• 20:36
  Sonia Singh MD: So if you wanna learn more about any particular of these subgroups, you can go there and see the full.
• 20:42
  Sonia Singh MD: Study or analysis that led to that that range.
• 20:45
  Sonia Singh MD: But for older adults, which is the category that has the most robust data, there's still debate around what the ideal number is.
• 20:52
  Sonia Singh MD: Some people say just 1.0 grams per kilogram per day is adequate.
• 20:55
  Sonia Singh MD: And other people will say, really, the range of 1.2 to 1.6 grams per kilogram per day is adequate.
• 21:00
  Sonia Singh MD: I think that's really what.
• 21:02
  Sonia Singh MD: Maybe the dietary guidelines are most they're looking at that data the most, maybe to come to that conclusion that is the recommended amount.
• 21:10
  Sonia Singh MD: But most of that data does come from older adults.
• 21:13
  Sonia Singh MD: Pregnant women should be getting a minimum of 1.2 grams per kilogram per day in early pregnancy, but up at least 1.5 kilograms per kilogram per day in later pregnancy Breastfeeding, women should be getting 1.1 to 1.3 grams per kilogram per day.
• 21:29
  Sonia Singh MD: Menopausal women.
• 21:30
  Sonia Singh MD: Again, area of debate.
• 21:31
  Sonia Singh MD: There's a lot of different stigma on this, but somewhere between 1.0 and 1.6 kilograms per day is what probably they should be getting.
• 21:40
  Sonia Singh MD: Obese patients who are on a GLP one should be getting at least 1.2 grams per kilograms per day.
• 21:46
  Sonia Singh MD: But using the fat-free mass or lean body weight, which is a very important caveat.
• 21:52
  Sonia Singh MD: Yeah.
• 21:52
  Sonia Singh MD: I think over a third of adults at this point would qualify by BMI for obesity.
• 21:57
  Sonia Singh MD: And if you're using that weight as what you use to calculate your protein needs, you're probably overestimating them quite a bit because there's a lot of fat mass or adipose tissue that is not contributing to any metabolic demands.
• 22:12
  Sonia Singh MD: And so using that.
• 22:14
  Sonia Singh MD: Full weight is probably not.
• 22:16
  Sonia Singh MD: Accurate.
• 22:17
  Sonia Singh MD: And the fat-free mask can be calculated a few different ways.
• 22:21
  Sonia Singh MD: The best way to do it is to actually have your body composition done, which is not a thing that we standardly do in traditional primary care offices.
• 22:28
  Sonia Singh MD: You can often get it at a gym or through a trainer, different very, a weight loss practice.
• 22:32
  Sonia Singh MD: But you may not have access to that.
• 22:34
  Sonia Singh MD: There's different formulas you can use to estimate fat-free mass.
• 22:37
  Sonia Singh MD: There's no consensus on one formula that's the best for this.
• 22:41
  Sonia Singh MD: There's two or three out there that people seem to think are reasonable.
• 22:45
  Sonia Singh MD: But all that to say I hope going through those numbers gives you a sense of how individualized this range is and how many factors will influence it.
• 22:55
  Sonia Singh MD: The fact that it blew my mind that in early pregnancy there's kind of one target and then it changes in later pregnancy.
• 23:01
  Sonia Singh MD: So that just tells you How much this number can change based on how active you are, what your current body composition is, what your other metabolic demands are.
• 23:11
  Sonia Singh MD: And so it's really, yes, there are a bunch of subgroups that would benefit from more protein, but the exact needs are very variable and depend on a lot of factors that, it, it are not accounted for in this kind of blanket general recommendation that's now out there.
• 23:28
  Rebecca Berens MD: Yeah.
• 23:29
  Rebecca Berens MD: And it's interesting to me most of these ranges are include the, high end of the previous one, which was like 0.8 to 1.2.
• 23:38
  Rebecca Berens MD: Yes.
• 23:39
  Rebecca Berens MD: Most of these ranges around there.
• 23:40
  Rebecca Berens MD: Some of them go again going up to 1.6, but I guess when I, when I used to counsel patients about that 0.8 to 1.2 grams per kilogram kind of estimate, I always would frame it as 0.8 is.
• 23:52
  Rebecca Berens MD: The bare minimum you need to function and if you are doing more, then you are gonna need more to replace that muscle.
• 24:02
  Rebecca Berens MD: So obviously it makes sense that yeah, if you're lifting weights and exercising a lot and trying to build muscle or if you're at risk of more muscle loss we need to make sure like it, so it makes sense to me.
• 24:12
  Rebecca Berens MD: I'm still, I guess maybe you're gonna get to this, but I'm still struggling to see how we got up to this new recommendation that's very much on the high end or past most of these ranges.
• 24:22
  Rebecca Berens MD: So I'm curious to hear how we get there, but I think it's really key also, like the we should do a whole episode on body composition because Yeah,
• 24:31
  Sonia Singh MD: sure.
• 24:32
  Rebecca Berens MD: Because I think that's the other thing that I think is, is entering into a lot of these conversations, but like you said, most people don't actually have access to that data.
• 24:40
  Sonia Singh MD: Right.
• 24:40
  Rebecca Berens MD: And so they're erring on the side of oh, I just need more then.
• 24:43
  Sonia Singh MD: Yes.
• 24:44
  Rebecca Berens MD: And because if you don't have the data to help you make the decision then, and you're trying to do the right thing, you're gonna err on I'm gonna make sure I hit the high range.
• 24:53
  Rebecca Berens MD: So that I, because I don't wanna underestimate.
• 24:54
  Rebecca Berens MD: And so maybe you're gonna get into this of what the risks of that are, but yeah.
• 24:58
  Rebecca Berens MD: I'm.
• 24:59
  Rebecca Berens MD: That I think would be a whole other conversation to have about how to help people better estimate their needs when we don't necessarily have access to the data to do that.
• 25:09
  Sonia Singh MD: Yeah.
• 25:09
  Sonia Singh MD: So what I would say in terms, so you're correct that if you were having.
• 25:14
  Sonia Singh MD: At the high end of the previous guidelines, which is the low end of the current guidelines, you're probably in a pretty safe spot, yeah.
• 25:21
  Sonia Singh MD: So 1.2 feels like a pretty safe place to put your money when you're looking at all of these ranges for all of these different things.
• 25:29
  Sonia Singh MD: I don't know what made them specifically choose.
• 25:32
  Sonia Singh MD: I suspect it's mostly this data that it is in older adults and that is in active, very active adults where, you do see some benefit from higher intakes.
• 25:42
  Sonia Singh MD: But yeah, I don't know that the majority of people in the nutrition community would get behind saying that this is the right range for all Americans.
• 25:50
  Sonia Singh MD: So one big point that I wanna make here is that, all these subgroups we talked about, they either have increased metabolic demands or they're in some kind of catabolic state where they're at risk for muscle breakdown.
• 26:00
  Sonia Singh MD: And it's important to note here that if you're just an average adult and you start eating more protein beyond what your metabolic needs are without concurrent weight training or resistance training or activity, You're not really gonna get anything out of it.
• 26:15
  Sonia Singh MD: It's just, it's gonna go away.
• 26:17
  Sonia Singh MD: I will acknowledge that it.
• 26:19
  Sonia Singh MD: Relatively safe and, but so safe in terms of toxicity.
• 26:25
  Sonia Singh MD: So the upper limit of tolerability for protein is like 3.5 grams per kilogram per day, which is honestly really hard to do.
• 26:32
  Sonia Singh MD: So I'm not really worried about a lot of people doing that.
• 26:35
  Sonia Singh MD: But you have to ask yourself what is that protein replacing for you and what is coming with it in your diet?
• 26:42
  Sonia Singh MD: If you're adding that much so that, we're gonna talk about that a little bit later, but I do wanna make the point that even the new dietary guidelines acknowledge.
• 26:50
  Sonia Singh MD: That just adding more protein without any change in activity is unlikely to benefit you.
• 26:55
  Sonia Singh MD: This is a direct quote.
• 26:56
  Sonia Singh MD: They say, although dietary protein can increase muscle mass and strength when combined with regular strength or resistance training, there is little evidence that absent sustained training, higher protein builds muscle or provides other health benefits.
• 27:08
  Sonia Singh MD: So they're acknowledging right there that if you're not doing the activity piece and you just up your protein intake and you're just a regular person.
• 27:16
  Sonia Singh MD: Probably nothing is going to happen or nothing positive is going to happen.
• 27:20
  Sonia Singh MD: Happen, I should say.
• 27:22
  Sonia Singh MD: And unfortunately, most US adults are sedentary.
• 27:25
  Sonia Singh MD: And so if you're not falling into one of those subgroups that I talked about that are at risk, it's unlikely to benefit you in a meaningful way to just be adding more protein.
• 27:34
  Sonia Singh MD: So the biggest point that I want to make about this and the part that makes me feel so strongly that a lot of this messaging is coming from people who don't live in the real world and don't.
• 27:45
  Sonia Singh MD: Talk to patients on a regular basis.
• 27:49
  Sonia Singh MD: Is that snarky?
• 27:49
  Sonia Singh MD: I don't wanna be snarky.
• 27:50
  Sonia Singh MD: That's one of our rules is to not be snarky, but I just, it comes across to me as as it as people don't realize, like how this is going to translate in real life to actual people who are going about trying to decide what to eat.
• 28:05
  Sonia Singh MD: Yeah.
• 28:07
  Sonia Singh MD: I think that when people hear this message of, oh look, the new dietary guidelines say we should eat more protein.
• 28:13
  Sonia Singh MD: No one's really sitting and reading the 10 pages of the guidelines that are printed for the way public.
• 28:17
  Sonia Singh MD: They're just getting this message and we're seeing it all over social media of you gotta be eating more protein, right?
• 28:22
  Sonia Singh MD: When they think eat more protein, at least most, the vast majority of the patients I talk to, they think meat, eggs, fish.
• 28:29
  Sonia Singh MD: Maybe they're thinking Greek yogurt.
• 28:31
  Sonia Singh MD: Cottage cheese, protein bars, protein shakes, protein powders.
• 28:36
  Sonia Singh MD: Yeah.
• 28:36
  Sonia Singh MD: That is mostly what comes to mind for the majority of Americans who are accustomed to the western way of eating.
• 28:43
  Sonia Singh MD: Those are mostly animal sources of protein or ultra processed foods, which we as Americans already consume way too much.
• 28:52
  Rebecca Berens MD: Yeah, way
• 28:53
  Sonia Singh MD: too much of right.
• 28:54
  Sonia Singh MD: There's very few things in nutrition that I feel really confident are true and gonna be true for a long time.
• 29:01
  Sonia Singh MD: And one of those things is that I think we see over and over.
• 29:06
  Sonia Singh MD: That the healthiest way to eat in terms of cardiovascular risk, cancer risk, inflammation, so many different things.
• 29:14
  Sonia Singh MD: Longevity is a whole foods plant-based diet that is low in ultra processed foods or a Mediterranean style diet and.
• 29:23
  Sonia Singh MD: The changes that I think would be prompted for the vast majority of Americans from hearing the message of I'm not eating enough protein, I need to eat more, are not really in line with those.
• 29:34
  Rebecca Berens MD: Yeah.
• 29:34
  Sonia Singh MD: With that dietary pattern.
• 29:36
  Sonia Singh MD: And so we should ask ourselves does this recommendation move most Americans closer to what we know is the healthiest way to eat?
• 29:43
  Sonia Singh MD: Or does it move them farther from it?
• 29:46
  Sonia Singh MD: And I want to acknowledge that protein can come from a lot of different sources and the guidelines just state, like I looked through and they have one line that's like.
• 29:56
  Sonia Singh MD: Protein should come from a mixture of plant and animal sources, but I don't think they really emphasize this, that plant-based plants can be also a source of very high quality protein.
• 30:08
  Sonia Singh MD: It's true that, animal sources are often a lot of bang for your buck and contain the essential amino acids and.
• 30:13
  Sonia Singh MD: If something contains all of the essential amino acids, the ones that you cannot synthesize, you consider it a complete protein.
• 30:19
  Sonia Singh MD: But there are actually plant sources that are also complete proteins that I think people just don't realize.
• 30:25
  Sonia Singh MD: So general sources of plant-based protein are things like lentils, legumes, grains, nuts, seeds, soy products.
• 30:30
  Sonia Singh MD: Examples of complete plant-based proteins are things like tofu, tempe, edamame, hemp seeds, chia seeds, quinoa, buckwheat, nutritional yeasts, spirulina.
• 30:40
  Sonia Singh MD: There's a lot of them.
• 30:42
  Sonia Singh MD: But those are the things, those are not the things that most people are going to immediately go to.
• 30:45
  Sonia Singh MD: Those are not the things that are readily available for most people in their environments or in the places that they're eating and shopping frequently.
• 30:53
  Sonia Singh MD: And so I think that, there's this tendency to lean on those animal sources and to immediately jump to those.
• 30:59
  Sonia Singh MD: But when you consume protein from an animal source, it's coming in with.
• 31:03
  Sonia Singh MD: Saturated fat.
• 31:05
  Sonia Singh MD: Often it's coming in with sodium and other things that are, it's not pure protein.
• 31:09
  Sonia Singh MD: It's coming with other stuff that typically we don't need more of.
• 31:13
  Sonia Singh MD: Whereas the plant-based proteins are gonna be coming in with fiber and antioxidants and all of these other, phytochemicals things that, you won't be getting as much of from meat products and.
• 31:24
  Sonia Singh MD: I wanna be fair to these guidelines.
• 31:26
  Sonia Singh MD: They did mention that there are plant sources of protein, but when you look at the, I don't even know what you call it.
• 31:32
  Sonia Singh MD: Is it a pyramid?
• 31:33
  Sonia Singh MD: I don't know.
• 31:33
  Sonia Singh MD: A new,
• 31:34
  Rebecca Berens MD: yeah,
• 31:34
  Sonia Singh MD: the upside down pyramid.
• 31:36
  Sonia Singh MD: A new triangle, I don't know.
• 31:38
  Sonia Singh MD: Maybe I'm not seeing, I don't even see beans on here and beans like the unsung hero of nutrition.
• 31:43
  Sonia Singh MD: It just breaks my art.
• 31:45
  Sonia Singh MD: That beans didn't make it onto the graphic.
• 31:47
  Sonia Singh MD: And the things at the very top are just meat.
• 31:51
  Sonia Singh MD: They're meat and vegetables.
• 31:51
  Sonia Singh MD: Meat and
• 31:52
  Rebecca Berens MD: cheese.
• 31:53
  Sonia Singh MD: They're meat, cheese, vegetables,
• 31:55
  Rebecca Berens MD: cheese.
• 31:55
  Rebecca Berens MD: Like why is the cheese on top?
• 31:57
  Rebecca Berens MD: Several lines above the avocado and the egg.
• 32:00
  Sonia Singh MD: It makes no sense.
• 32:01
  Sonia Singh MD: And why, why is, why are oats and nuts like so low down, yeah.
• 32:05
  Sonia Singh MD: And I don't know, to me, like I've had my own journey with my own nutritional knowledge for so many years.
• 32:12
  Sonia Singh MD: I don't counsel people the way I counseled them 10 years ago or even maybe five years ago.
• 32:16
  Sonia Singh MD: One of the big.
• 32:17
  Sonia Singh MD: Schemes of these guidelines is eat real food.
• 32:19
  Sonia Singh MD: And I think I mentioned one of my other episodes, I went through a whole phase where I was like, I'm only eating real food.
• 32:23
  Sonia Singh MD: Everything else is poison.
• 32:24
  Sonia Singh MD: Like I've been there, I've been there, I've done that.
• 32:27
  Sonia Singh MD: Yeah.
• 32:27
  Sonia Singh MD: And I have a lot of patients who I think perceive that the healthiest possible meal is.
• 32:33
  Sonia Singh MD: A hunk of lean protein and a bunch of veggies.
• 32:35
  Sonia Singh MD: And it's a challenge to convince them actually, no, it's okay to eat grains.
• 32:39
  Sonia Singh MD: It's okay to eat a whole grain.
• 32:40
  Sonia Singh MD: It's okay to eat a starch.
• 32:41
  Sonia Singh MD: It's okay to eat fruit.
• 32:42
  Sonia Singh MD: It's okay to eat these other things that are not just protein and veggies.
• 32:47
  Sonia Singh MD: And I think that's just a collective misunderstanding that we seem to have come to.
• 32:52
  Sonia Singh MD: These guidelines are falling into that kind of misunderstanding without acknowledging no, that actually that is not the ideal meal, and that is not what the evidence tells us we should be eating.
• 33:01
  Rebecca Berens MD: Yeah.
• 33:02
  Rebecca Berens MD: Anyway.
• 33:02
  Rebecca Berens MD: I think also like to your point about what does this actually translate to for a patient?
• 33:09
  Rebecca Berens MD: It doesn't translate to them eating real food, as you said, and you know what I what I see, and I'm sure what you see also, and what I think we see in on social media is a lot of marketing of products that have added protein, right?
• 33:22
  Rebecca Berens MD: That are in no way anything like a real food or if we're gonna, in quotes, real food, right?
• 33:28
  Rebecca Berens MD: They're not a whole food, they're not a.
• 33:30
  Rebecca Berens MD: If your line is gonna be eat real food and then your other line is you need to eat this much protein, it is not going to happen in that way for most people.
• 33:37
  Rebecca Berens MD: 'cause like you said, it, the ability to actually sit and prepare a cooked meal of meat and vegetables for each meal is just not gonna happen.
• 33:46
  Rebecca Berens MD: And.
• 33:47
  Rebecca Berens MD: The way that most people need to get their protein sources in is in more shelf stable and easier to access and easier to prepare ways.
• 33:55
  Rebecca Berens MD: So yeah, that's why beans are so great because you can them and they can sit on your shelf forever and they take five seconds to make versus cutting all the pieces off of fat off a steak and then grilling it.
• 34:07
  Rebecca Berens MD: Yes.
• 34:07
  Rebecca Berens MD: And it just is not gonna happen.
• 34:08
  Rebecca Berens MD: And but it's just, it's so interesting how.
• 34:11
  Rebecca Berens MD: By outta one side of your mouth, you're saying eat more real food.
• 34:15
  Rebecca Berens MD: And out of the other side you're saying you need to eat this much protein by default.
• 34:19
  Rebecca Berens MD: What EV everyone is gonna go to is here's this product with added protein.
• 34:22
  Rebecca Berens MD: Yes.
• 34:22
  Rebecca Berens MD: So now I can buy it and I can hit my needs and yeah.
• 34:26
  Rebecca Berens MD: Now you're eating like.
• 34:28
  Rebecca Berens MD: A Frankenstein waffle.
• 34:29
  Sonia Singh MD: Yes.
• 34:30
  Sonia Singh MD: The Frankenstein is a great word for it.
• 34:32
  Sonia Singh MD: I had a couple come see me a couple weeks ago.
• 34:35
  Sonia Singh MD: Lovely couple really motivated to eat and be healthy and make the right choices and just trying so, so hard.
• 34:42
  Sonia Singh MD: But then, they're telling me yeah, we eat protein bagels and then I eat these protein chips as my snack, and I'm this is, this is a big misconception where I know that you're trying to do the right thing.
• 34:53
  Sonia Singh MD: You're motivated to, you have the resources, you have the time, but you think that these things are serving you and they probably are not.
• 35:00
  Sonia Singh MD: And they're just all their other ultra processed foods, yeah.
• 35:03
  Sonia Singh MD: And
• 35:04
  Rebecca Berens MD: they're more expensive.
• 35:05
  Sonia Singh MD: They are more expensive.
• 35:06
  Sonia Singh MD: It's true.
• 35:07
  Sonia Singh MD: Yeah.
• 35:07
  Rebecca Berens MD: And and I don't wanna demonize the Frankenstein waffle because I.
• 35:11
  Rebecca Berens MD: Frankenstein waffles can be really beneficial.
• 35:13
  Rebecca Berens MD: And I do recognize I see a lot of patients who are recovering from eating disorders and who really struggle with, certain types of foods, certain textures, patients maybe with a I who like really can't get their protein in from, these typical meat and bean sources just for those reasons.
• 35:27
  Rebecca Berens MD: And they have a place.
• 35:28
  Rebecca Berens MD: And I just, I wanna acknowledge that'cause I don't wanna say that there's wrong to eat these things.
• 35:33
  Rebecca Berens MD: But I think to try to.
• 35:35
  Rebecca Berens MD: Push everyone towards that and away from other cheaper options is also not beneficial.
• 35:42
  Rebecca Berens MD: And it just it creates a lot more confusion.
• 35:45
  Rebecca Berens MD: And like you said, it's really, it's pushing people to spend more money on foods that are not serving them as well as cheaper, easier for more basic foods, could serve them.
• 35:56
  Sonia Singh MD: No, I totally agree with you.
• 35:57
  Sonia Singh MD: And my kid, my kids eat plenty of Frankenstein products.
• 36:00
  Sonia Singh MD: Oh yeah.
• 36:01
  Sonia Singh MD: So I am not I am not completely opposed to the Frankenstein products, but if I were to rewrite these guidelines, I would've wished that there would've been a stronger emphasis on thinking about the source of protein and the quality of that source of protein, prioritizing plant-based proteins, which we know, Americans don't eat very much of.
• 36:19
  Sonia Singh MD: And then.
• 36:20
  Sonia Singh MD: Having a mentioning if you're unable to reach your protein goals with Whole Foods which is very possible and realistic.
• 36:27
  Sonia Singh MD: That that's it's probably a common problem.
• 36:29
  Sonia Singh MD: I have plenty of patients that are trying to eat a little bit more protein, but.
• 36:33
  Sonia Singh MD: Their cholesterol is high, so they really don't wanna be having more animal products or more, meat.
• 36:37
  Sonia Singh MD: And they feel like, oh my God is there anything for me?
• 36:39
  Sonia Singh MD: I can only eat so much beans and lentils, and so I think for them it is reasonable to do, I have vegetarians who they do need to do a little bit of protein powder or something to get there.
• 36:48
  Sonia Singh MD: And I think having a caveat that's yes, you can you can consider use of some of these products to help you reach your goals, but be aware of what you're replacing with those, or that, they may not always be necessary or they may come with other added things that you don't actually need more of.
• 37:04
  Sonia Singh MD: So anyway I feel.
• 37:06
  Sonia Singh MD: I don't feel as angry about the actual, number that they've chosen as the requirement for the protein.
• 37:13
  Sonia Singh MD: But I think this is one of those cases where thinking about the context and the nuance and how this actually translate translates in real life to people is really key.
• 37:22
  Sonia Singh MD: And I'm concerned that this is going to translate actually into worse health outcomes based on people relying more heavily on animal products that we already know to not be.
• 37:33
  Sonia Singh MD: As supportive of long-term health and, good health.
• 37:36
  Rebecca Berens MD: Yeah.
• 37:37
  Rebecca Berens MD: And like you said, in terms of the thinking about what's actually actionable and sustainable for people to add into their life.
• 37:43
  Rebecca Berens MD: That is maybe you could argue is not, shouldn't be part of the dietary guidelines, but I would not argue that.
• 37:48
  Rebecca Berens MD: I think that there is a real gap here in acknowledging how we got to this point of not eating.
• 37:56
  Rebecca Berens MD: As much, quote unquote real food.
• 37:59
  Rebecca Berens MD: And what are the societal barriers that are in place that have gotten us there?
• 38:04
  Rebecca Berens MD: Because it does really.
• 38:06
  Rebecca Berens MD: Again, push this towards this is a an individual choice problem.
• 38:09
  Rebecca Berens MD: You can just choose the thing with more protein added and then you'll be meeting these guidelines.
• 38:13
  Rebecca Berens MD: Yeah.
• 38:13
  Rebecca Berens MD: Versus Hey, why do you have to work three jobs to be able to feed your kids and you don't have time to cook?
• 38:18
  Rebecca Berens MD: So then you're picking up stuff.
• 38:19
  Rebecca Berens MD: There's a lot of, there's a lot of factors there that are affecting people's ability to eat real food that has very little to do with what people are.
• 38:28
  Rebecca Berens MD: Consciously choosing and more to do with what is accessible and available and, sustainable for them to fit into their life.
• 38:35
  Sonia Singh MD: No, that's totally true.
• 38:36
  Sonia Singh MD: And actually I have to go back and look at it again to see if they even mentioned this, but people's dietary choices don't exist in a vacuum, and so some acknowledgement of just what drives dietary choices and how those, how that happens, I think that would be a great addition to the dietary guide,
• 38:52
  Rebecca Berens MD: And what we're doing as the government to better support everyone in being able to make better choices.
• 38:58
  Rebecca Berens MD: Didn't see a lot of that.
• 38:59
  Rebecca Berens MD: But anyway.
• 38:59
  Sonia Singh MD: No.
• 39:00
  Sonia Singh MD: Okay.
• 39:01
  Sonia Singh MD: We always like to end the episode with what can we take from this as doctors and as humans, and I would say.
• 39:07
  Sonia Singh MD: As doctors, I think again, we just have to remember people are so hungry for this knowledge and they want to know.
• 39:14
  Sonia Singh MD: And if you don't know and you don't talk to them about it, they're going to go to another source that may not be as evidence-based.
• 39:20
  Sonia Singh MD: And so I think it's important that we maintain our nutritional knowledge and have some familiarity with these numbers.
• 39:26
  Sonia Singh MD: And also just emphasize that it is not a one size fits all thing.
• 39:30
  Sonia Singh MD: The guidelines are the guidelines, but you really should be thinking about your individual situation and talking to some kind of professional about how, how that relates to you and how that can apply to you.
• 39:41
  Sonia Singh MD: I think that if a patient comes to me and mentions that they're wanting to increase their protein intake, I would try to start with.
• 39:48
  Sonia Singh MD: Kind of getting an estimate of maybe what they're consuming now, what their level of activity is, what their needs are.
• 39:54
  Sonia Singh MD: I think that's just step one.
• 39:55
  Sonia Singh MD: As we talked about, you may not ever, I don't have a body composition machine in my practice.
• 39:59
  Sonia Singh MD: I may not ever have a totally accurate number.
• 40:03
  Sonia Singh MD: I think that, 1.2 grams per kilogram per day range is like a pretty.
• 40:08
  Sonia Singh MD: Safe range to start with for kind of your average adult.
• 40:12
  Sonia Singh MD: I acknowledge that most people in their primary care practices are not gonna have time to take like a full dietary history on somebody and may not have time to have this conversation.
• 40:21
  Sonia Singh MD: In that case, you can lean on your registered dietician colleagues, although I will also acknowledge that often you cannot see a registered dietician unless you have a diagnosis that your insurance will cover the dietician for.
• 40:32
  Sonia Singh MD: So there are many barriers to having these conversations in real life and getting the kind of, support some people are wanting around this.
• 40:40
  Sonia Singh MD: I think also just, just acknowledging or validating for patients that this is just a really confusing, this is a really confusing space and the marketplace is really confusing and can be really overwhelming.
• 40:51
  Sonia Singh MD: I just, I hear that a lot from patients.
• 40:53
  Sonia Singh MD: I had a patient who was just like, I don't know, I was standing in the yogurt aisle and I just didn't know what to pick.
• 40:57
  Sonia Singh MD: And so I didn't buy any of them because I was just so confused.
• 41:01
  Sonia Singh MD: And I don't think, as the doctor.
• 41:03
  Sonia Singh MD: Most of the time you're not gonna have the answer of this is the product and that's not what you need to do.
• 41:07
  Sonia Singh MD: But just validating that yeah, that's hard.
• 41:10
  Sonia Singh MD: That is really hard.
• 41:11
  Sonia Singh MD: And like you said earlier, consuming real food, having following the dietary guidelines is also hard and it's not easy and it's not realistic for a lot of people to achieve that, all the time.
• 41:23
  Sonia Singh MD: Yeah.
• 41:23
  Sonia Singh MD: And then.
• 41:24
  Sonia Singh MD: I think as patients, I would just give people the reminder that on average most of us are actually probably meeting or pretty close to the guidelines.
• 41:32
  Sonia Singh MD: This feeling of scarcity of none of us are getting enough and we're all wasting away.
• 41:37
  Sonia Singh MD: I don't think that's actually true.
• 41:40
  Sonia Singh MD: And we do need to be mindful about how much we're consuming, but the advice that's right for your friend or your sister or the guy down the street, or your trainer may not be the right advice for you.
• 41:49
  Sonia Singh MD: So don't feel, be wary of comparing yourself to others.
• 41:53
  Sonia Singh MD: And also just remember that there are trends in nutrition, just like there are trends in everything else.
• 41:58
  Sonia Singh MD: Just like there's trends in fashion and what body type is popular.
• 42:02
  Sonia Singh MD: We're in a protein era right now, but there're gonna, there's gonna be a new era at some point.
• 42:08
  Sonia Singh MD: Yeah.
• 42:08
  Sonia Singh MD: So take all of this messaging with a grain of salt.
• 42:11
  Sonia Singh MD: That's how I see it, is okay, we're on this, we're on this train now.
• 42:14
  Sonia Singh MD: But I really hope the next train is fiber.
• 42:16
  Sonia Singh MD: 'cause I really love fiber and I,
• 42:18
  Rebecca Berens MD: so I, I love fiber too, that has already started with the whole fiber mounting.
• 42:22
  Sonia Singh MD: But fiber maxing.
• 42:23
  Rebecca Berens MD: Which, which absolutely needs to be a future episode about fiber maxing.
• 42:27
  Rebecca Berens MD: But I also think fat's kind of coming back, but fat, everyone was anti-fat for a while.
• 42:32
  Rebecca Berens MD: Then there were anti carb.
• 42:32
  Rebecca Berens MD: Eventually people are gonna be anti protein soon.
• 42:34
  Rebecca Berens MD: There's not gonna be anything that we're allowed to eat anymore.
• 42:37
  Sonia Singh MD: That will be a dark time.
• 42:40
  Rebecca Berens MD: So I think, you and I both love our dietician colleagues and and that is, even though we both have a lot of time, I still heavily rely on me too dietician colleagues because they do have more education in this than I do.
• 42:53
  Rebecca Berens MD: I think I probably have more nutrition education than maybe the average doctor, but not anything like what a dietician has.
• 43:00
  Rebecca Berens MD: And so I do really think it's important to, to keep that in mind.
• 43:03
  Rebecca Berens MD: But yeah it's a confusing world out there.
• 43:07
  Sonia Singh MD: My husband actually told me about fiber maxing a few weeks ago, and he said he listened to a podcast episode about it, and I was like what is it?
• 43:13
  Sonia Singh MD: And he's they basically just said eat a bunch of high fiber foods to get a lot of fiber.
• 43:18
  Sonia Singh MD: So anyway, I don't know if that's what it's, but I was like, okay, I can, is that a trend I can get behind?
• 43:24
  Sonia Singh MD: I like that
• 43:26
  Rebecca Berens MD: Until the horrific GI issues start because people are overdosing themselves on fiber.
• 43:31
  Sonia Singh MD: Okay.
• 43:32
  Sonia Singh MD: Yes.
• 43:32
  Sonia Singh MD: I that we should add that to our list of topics.
• 43:34
  Rebecca Berens MD: Oh yes, absolutely.
• 43:35
  Sonia Singh MD: Absolutely.
• 43:36
  Sonia Singh MD: I would love to talk about fiber and fiber maxing.
• 43:38
  Sonia Singh MD: Okay.
• 43:39
  Sonia Singh MD: Where can people go for more info?
• 43:40
  Sonia Singh MD: We are gonna put links to our substack in the show notes.
• 43:44
  Sonia Singh MD: Our substack will house a written summary of our discussion today, all of the links and resources.
• 43:49
  Sonia Singh MD: There are a ton of references for this episode.
• 43:51
  Sonia Singh MD: And then I have a couple of patient friendly.
• 43:54
  Sonia Singh MD: Links as well that are sourced and vetted and you can go there yourself if you're a patient or if you're a doctor, you can send patients there as well as a few experts on Instagram and social media to follow, to balance out some of the other content you might be seeing.
• 44:08
  Rebecca Berens MD: Thanks.
• 44:08
  Rebecca Berens MD: So this was a great conversation.
• 44:10
  Sonia Singh MD: Yep.
• 44:11
  Sonia Singh MD: So that brings us to the end of the episode.
• 44:12
  Sonia Singh MD: Thanks for joining us.
• 44:13
  Rebecca Berens MD: Thanks.
• 44:15
  Sonia Singh MD: Hey guys, last but not least, we have a very important disclaimer.
• 44:19
  Sonia Singh MD: This podcast is intended for educational and entertainment purposes only.
• 44:23
  Sonia Singh MD: The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation diagnosis.
• 44:37
  Sonia Singh MD: Or treatment.
• 44:38
  Sonia Singh MD: Listening to this podcast does not establish a physician patient relationship between you and the hosts.
• 44:43
  Sonia Singh MD: We are doctors, but not your doctors.
• 44:46
  Sonia Singh MD: Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances.
• 44:53
  Sonia Singh MD: Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health, medical conditions, or treatment options.
• 45:00
  Sonia Singh MD: Never disregard or delay medical advice because of something you've heard on this podcast.
• 45:05
  Sonia Singh MD: While the hosts are licensed physicians, the views and opinions expressed are our own and do not represent those of our employers, institutions, organizations, or professional societies with which we are affiliated, although we do our best to stay up to date.
• 45:19
  Sonia Singh MD: Please note that this podcast includes discussion of.
• 45:21
  Sonia Singh MD: Emerging research, evolving medical concepts and differing professional opinions.
• 45:26
  Sonia Singh MD: Medicine is not static and information may change over time.
• 45:30
  Sonia Singh MD: We, the hosts make no guarantees about the accuracy completely, or applicability of this content, and we disclaim any liability for actions taken or not taken based on the information provided in this podcast by listening to the Antisocial Doctors podcast, you have agreed to these terms.
• 45:45
  Sonia Singh MD: Thanks again for joining us.