Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / What's the deal with protein?

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What's the deal with protein? · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:01
Speaker 1: Hey, everybody, Just a quick correction from last week. At
0:04
Speaker 1: the end of the episode. In the mailbag, we were
0:05
Speaker 1: talking about colon cancer screening and I said that the
0:08
Speaker 1: colon guard test is done yearly. That's not right, It's
0:10
Speaker 1: done every three years. The fit testing, which is another
0:14
Speaker 1: forum of stool based testing, is the yearly colon cancer
0:17
Speaker 1: screening test. Thanks so much to amazing doctor Clay Ackerley
0:20
Speaker 1: for pointing that out for us. Now onto the episode.
0:24
Speaker 2: Hi, Perry, high, Emily, nice to see you, you too?
0:29
Speaker 2: Which has more protein?
0:30
Speaker 3: Cup of cottage cheese or a cup of Greek yogurt?
0:33
Speaker 1: Oh? Why are you doing this to me? I am
0:35
Speaker 1: going to say a cup of cottage cheese with low confidence.
0:39
Speaker 3: Excellent, one score of one. Okay.
0:43
Speaker 2: Second question, high demand for what product led to weigh
0:48
Speaker 2: protein being primarily the source of protein for protein shakes,
0:55
Speaker 2: cheese generally cheese is the correct?
0:58
Speaker 1: Okay?
0:58
Speaker 3: Cancer?
0:59
Speaker 1: All right of two?
1:00
Speaker 3: Okay, very hard. Last question.
1:03
Speaker 2: There is a new protein product called a David protein bar.
1:06
Speaker 2: It has a lot of protein. The company that makes
1:09
Speaker 2: it introduced a second product to expand their line. What
1:14
Speaker 2: is that second product?
1:16
Speaker 1: It's gotta be Goliath.
1:21
Speaker 3: No, And that's on the table. They left that on
1:25
Speaker 3: the table.
1:25
Speaker 2: The new product is frozen cod Oh, and that's all
1:30
Speaker 2: you need to know about protein.
1:33
Speaker 1: Wow. So, I, in anticipation of this episode, for the
1:38
Speaker 1: first time really ever, tracked everything I put into my body,
1:44
Speaker 1: everything I ate for a few days because I had
1:46
Speaker 1: no idea how much protein I was taking it. And
1:49
Speaker 1: I will tell you two things. Number One, I don't
1:51
Speaker 1: like writing down everything that I eat. It's annoying, it's
1:56
Speaker 1: hard to search for I don't know what portion sizes
1:59
Speaker 1: are and it makes me feel guilty. And two, the
2:02
Speaker 1: amount of protein I intake from day to day varies
2:06
Speaker 1: wildly and depends almost entirely on whether my kids are
2:10
Speaker 1: having pasta for dinner or not.
2:12
Speaker 3: What was your protein number?
2:14
Speaker 1: So the highest day I had was one hundred and
2:17
Speaker 1: fifty grams and the lowest day I had was sixty grams.
2:21
Speaker 3: Wow, that is a lot of variation.
2:23
Speaker 2: Yeah, I eat exactly the same amount of protein every
2:27
Speaker 2: single day.
2:28
Speaker 1: I think that may say everything anyone needs to know
2:31
Speaker 1: about the two of us. Should we dig into this?
2:34
Speaker 3: We should.
2:38
Speaker 2: I'm Emily Aster, I'm an economist and a data expert.
2:41
Speaker 1: And I'm Perry Wilson. I'm a medical doctor.
2:44
Speaker 2: It's Thursday, April ninth, twenty twenty six, and this is wellness.
2:48
Speaker 1: Actually, because you're getting a staggering amount of health and
2:52
Speaker 1: wellness information nowadays from every source imaginable, and some of
2:56
Speaker 1: it is awesome.
2:57
Speaker 2: And some of it is well actually both Fortunately we
3:02
Speaker 2: are both people who know how to read studies, how
3:05
Speaker 2: to parse the data, and can tell you what's worth
3:07
Speaker 2: thinking about and what you can safely ignore.
3:10
Speaker 1: But before we dig in, a note that this podcast
3:13
Speaker 1: is for educational purposes and should not be construed as
3:15
Speaker 1: medical advice. We don't know your unique situation, so talk
3:19
Speaker 1: to your doctor for personal health decisions.
3:22
Speaker 3: This week we're asking what's the deal with protein?
3:25
Speaker 2: Perry and I will give the official smash her pass
3:27
Speaker 2: and then we'll get to your question of the week.
3:30
Speaker 2: But first let's do the health news roundup after the break.
3:45
Speaker 2: And now for the health news of the week, Perry,
3:48
Speaker 2: there was a lot of GLP one news this week.
3:52
Speaker 2: New GLP one drugs approved, some new research on dosing.
3:58
Speaker 2: What is your favorite piece of GLP one news for
4:01
Speaker 2: the week.
4:03
Speaker 1: I mean, I think it's got to be the approval
4:06
Speaker 1: of the new oral GLP one pill. It is the
4:11
Speaker 1: hardest thing to pronounce the generic name or for glepron
4:14
Speaker 1: terrible or forglepron. The brand name is FOUNDEO, which is
4:18
Speaker 1: a little bit easier from Lily, is now FDA approved
4:22
Speaker 1: for people with obesity or overweight with at least one
4:26
Speaker 1: comorbid condition. This is a GLP one drug interacts with
4:31
Speaker 1: a GLP one receptor, but it's not a peptide. Go
4:34
Speaker 1: back to the peptide episodes to hear about how what
4:36
Speaker 1: is a peptide. FOUNDEO is a small molecule that does
4:41
Speaker 1: interact with the receptor, but not the way the peptide does,
4:44
Speaker 1: so it's its own new thing.
4:46
Speaker 2: And the weight loss on this oral is a little
4:49
Speaker 2: bit less than in the studies than we've seen with
4:52
Speaker 2: something like zep bound, so maybe more like thirteen percent
4:54
Speaker 2: rather than about twenty which is what you're seeing with
4:57
Speaker 2: zep bound. But obviously or dosing far far easier for
5:02
Speaker 2: many people than injection based dosing.
5:05
Speaker 1: Yeah, I think this lowers the barrier so much. I
5:08
Speaker 1: anticipate this will be used pretty broadly. Right now for
5:13
Speaker 1: cash pay patients, they're pricing this at like three hundred
5:15
Speaker 1: and fifty dollars a month, that's still pretty pricey, but
5:18
Speaker 1: you know, most insurance plans will cover this if you have,
5:22
Speaker 1: you know, an appropriate condition.
5:23
Speaker 3: Where do they come up with these names? Is my
5:25
Speaker 3: main question?
5:26
Speaker 2: Like who thought or or flogged leaparon was a good
5:30
Speaker 2: even as a generic I don't love it.
5:32
Speaker 1: There are actually weird rules like for generic names, like
5:35
Speaker 1: they have to have certain combinations of letters depending on
5:38
Speaker 1: what type of drug they are, So I suspect the
5:40
Speaker 1: like g l ip in there like has to be
5:42
Speaker 1: in there for some reason, and then things get kind
5:44
Speaker 1: of thrown together.
5:45
Speaker 3: But can't just be like skinny pill, skinny.
5:49
Speaker 1: Pill, skinny riz or something skinny ris that could be
5:53
Speaker 1: a brand name trademark, don't take it.
5:57
Speaker 2: Second piece of GLP one news, which I think was
6:01
Speaker 2: not very surprising, but there is a retrospective case series
6:05
Speaker 2: that suggested that people can keep weight off in a
6:10
Speaker 2: maintenance phase with reduced frequency dosing of GLP ones. In
6:15
Speaker 2: the case of this case series, they were talking about
6:20
Speaker 2: dosing every other week rather than every week. This isn't
6:25
Speaker 2: very surprising since everyone is already doing this anyway, sometimes
6:28
Speaker 2: with the permission of their doctor and sometimes not. But
6:31
Speaker 2: I think it is the first of what's likely to
6:33
Speaker 2: be a more rigorous set of studies looking at what
6:36
Speaker 2: is the long term maintenance approach to GLP ones, since
6:41
Speaker 2: we know people go totally off them, they regain a
6:43
Speaker 2: lot of weight, but most people don't want to stay
6:45
Speaker 2: on the higher dose forever. So I think we'll see
6:48
Speaker 2: we'll see more of that as this becomes just a
6:50
Speaker 2: more mature market and a more mature set of science.
6:54
Speaker 1: Yeah, couldn't agree more. I could see a little bit
6:56
Speaker 1: of data coming through, but I agree. Not not super newsy,
6:59
Speaker 1: but it's to know at least that there weren't, you know,
7:01
Speaker 1: crazy adverse effects and that people kept the weight off
7:04
Speaker 1: with that reduced dozing.
7:06
Speaker 3: All right.
7:06
Speaker 2: Two other small things that I want to get your
7:10
Speaker 2: thoughts on. One is that benzyl alcohol has been named
7:13
Speaker 2: the Allergen of the Year by the American Contact Dermatitis Society.
7:20
Speaker 1: Congratulations benzyl alcohol.
7:23
Speaker 2: Until all the nomination, wondering who were the other who
7:26
Speaker 2: are the other nominees?
7:27
Speaker 1: Uh?
7:27
Speaker 3: Well, who are the other nominees for Allergen of the year? Uh?
7:31
Speaker 3: What is this? Why do people do this?
7:34
Speaker 1: I think it's I have this like passion for very small,
7:41
Speaker 1: insular groups of people. That care a lot about their
7:44
Speaker 1: very small, insular thing. Like I love like niche conventions
7:51
Speaker 1: where they're talking about like you know, new shoelace design
7:54
Speaker 1: or something, and people are having these heated arguments. But
7:57
Speaker 1: so contact dermatitis this is important. I don't mean to
8:00
Speaker 1: make fun, but having an allergen of the Year is
8:02
Speaker 1: kind of funny. Contact dermatitis is a rash you get
8:04
Speaker 1: on your skin from it being in contact with a
8:08
Speaker 1: potential allergen. And what the Contact Dermatitis Society is trying
8:12
Speaker 1: to get us all to talk about by labeling benzyl
8:16
Speaker 1: alcohol as their Allergen of the Year is that this
8:19
Speaker 1: is not a widely recognized allergen, although it is quite common.
8:24
Speaker 1: So this is an alcohol that's kind of like a floral,
8:28
Speaker 1: pleasant flowery smell, and so it's added to a lot
8:31
Speaker 1: of like fragrances and beauty products, particularly to give that
8:36
Speaker 1: kind of like floral fragrance. And it's not tested for
8:39
Speaker 1: in the standard skin testing for dermatitis. And so if
8:45
Speaker 1: you know you're one of the people that gets like
8:46
Speaker 1: weird reactions on their skin to something, and even if
8:49
Speaker 1: you've been to a doctor and maybe gotten some patch
8:51
Speaker 1: testing that hasn't revealed a particular allergen. You know, think
8:55
Speaker 1: about benzyl alcohol.
8:58
Speaker 3: Think about ben'syl alcohol. It's it's having a moment.
9:02
Speaker 2: I also love niche societies as an economist. You know,
9:06
Speaker 2: we have our own niche societies here and it's a delight.
9:10
Speaker 1: Absolutely. Another niche thing that is, I guess getting quite
9:15
Speaker 1: a bit less niche right now is is kratom. And
9:19
Speaker 1: I might not be pronouncing that correctly. Kratom KRATM is
9:23
Speaker 1: a substance that you can buy at like gas stations
9:26
Speaker 1: and stuff like that. It's not illegal as of yet,
9:29
Speaker 1: but calls to poison control have gone up by about
9:35
Speaker 1: twentyfold over the past fifteen years or so. From the substance.
9:40
Speaker 1: What it is is a chemical that is a partial
9:44
Speaker 1: agonist of the MEW opioid receptors, and that means that
9:48
Speaker 1: it binds to the same receptors as things like heroin
9:51
Speaker 1: and morphine. It's a partial agonist, so it's not quite
9:54
Speaker 1: as strong, which is I think why it hasn't risen
9:57
Speaker 1: to the level of like a national crisis yet. It
10:00
Speaker 1: has some weird dosing effects where like low doses cause
10:02
Speaker 1: sedation but higher doses cause agitation. Bit of a strange drug,
10:06
Speaker 1: but want to call it out there, you probably just
10:09
Speaker 1: in general, should not be taking anything that you buy
10:12
Speaker 1: at the gas station.
10:15
Speaker 2: I don't disagree with that, I will say, you know,
10:17
Speaker 2: I saw this in the CDC's MMWR, which is a
10:21
Speaker 2: great publication that I enjoy, and they are tracking changes
10:25
Speaker 2: in exposure from twenty fifteen to twenty twenty five and
10:28
Speaker 2: looking at the increase in exposure and they have this number.
10:32
Speaker 2: There's a twelve hundred percent increase in exposure reports, which
10:37
Speaker 2: of course over this ten year period, which of course
10:39
Speaker 2: is a lot, but it does start at two hundred
10:42
Speaker 2: and fifty eight and goes up to three thousand and
10:44
Speaker 2: five hundred, so it's worth remembering. You know, there are
10:47
Speaker 2: three hundred and thirty million people in America now, not
10:51
Speaker 2: all of them are purchasing this kratum kreatum item at
10:55
Speaker 2: the gas station, but this is still a fairly small number,
11:00
Speaker 2: although the percent increase is very large.
11:02
Speaker 1: So, yeah, getting more popular, don't take.
11:05
Speaker 3: It getting more popular.
11:06
Speaker 2: And I agree, purchasing psychoactive substances at the gas station
11:09
Speaker 2: to take is probably just like not something that you
11:12
Speaker 2: need to be doing, So don't do that.
11:14
Speaker 1: Pass on, let's forget.
11:15
Speaker 3: You can buy gum.
11:16
Speaker 2: If you need anything, purchase some gum, sure free gum.
11:19
Speaker 2: All right, So that's it for the health news of
11:21
Speaker 2: the week. When we come back, we will talk about protein.
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Speaker 1: So Emily, I'm old enough to have lived through like
11:32
Speaker 1: multiple macronutrient fads. I remember the low fat craze and
11:37
Speaker 1: then the low.
11:38
Speaker 3: Carb phrase bacon only, bacon only.
11:41
Speaker 1: Keto, bacon only. These were the happiest days of my life.
11:45
Speaker 1: You know, it was good. But like, clearly we are
11:50
Speaker 1: in the protein phase right now, right this is this
11:53
Speaker 1: is protein's time.
11:55
Speaker 3: It's protein's moment, at least one of its moments.
11:58
Speaker 2: You know, I could be drinking protein coffee right now
12:01
Speaker 2: that I could make with protein water, and I could
12:04
Speaker 2: have protein popcorn on the side.
12:06
Speaker 3: And that seems notable because in the past.
12:10
Speaker 2: You've really only been able to get protein out of
12:12
Speaker 2: regular protein sources and not out of your water. But
12:15
Speaker 2: now you can get it in your water. And the
12:18
Speaker 2: question is is that good?
12:20
Speaker 3: Is that good?
12:21
Speaker 1: Is that good? Let's let's figure it out, am my
12:24
Speaker 1: personal scale protein and water. I like that metric. I like,
12:27
Speaker 1: if it is in your water, then it is having
12:29
Speaker 1: in a moment caffeine maybe had its moment too. Now
12:32
Speaker 1: that can get calculated water. My metric is Costco. So
12:37
Speaker 1: I don't know if you've been in Costco, but that
12:39
Speaker 1: like snacky aisle that you walk down to get the
12:42
Speaker 1: bulk snacks for your kids lunches and stuff. Or you
12:44
Speaker 1: probably don't because you're a good mother, and but I do,
12:47
Speaker 1: and I don't have a Costco.
12:49
Speaker 3: Near here unfortunately, which is very sad.
12:52
Speaker 1: Well, in my Costco, the entire aisle is protein. Like
12:56
Speaker 1: it says protein on every single snack thing, and they
13:01
Speaker 1: know what they're doing, so yes, it is the protein.
13:05
Speaker 1: Era is that good?
13:07
Speaker 3: Is that good? So let's before we get into is
13:09
Speaker 3: that good? Or how much?
13:10
Speaker 2: And I think people have some pretty basic questions like
13:13
Speaker 2: do I actually need as much as people say? And
13:17
Speaker 2: could I have an infinite amount of protein? But let's
13:19
Speaker 2: like start at the beginning, because I think at all
13:21
Speaker 2: of these conversations there is a moment when you almost
13:24
Speaker 2: don't want to ask like what is this? You know,
13:27
Speaker 2: when you're like snacking on your protein powder. You got
13:30
Speaker 2: to start at the top.
13:31
Speaker 3: So let me start by asking you just what is protein?
13:35
Speaker 1: Yeah? Such an important question? What is protein? Okay? We
13:40
Speaker 1: often talk of the three macro nutrients, so carbohydrates, which
13:44
Speaker 1: is sugars and starches, fats, fats and oils and things
13:48
Speaker 1: like that, and then this protein thing. And protein is
13:52
Speaker 1: far and away the most interesting of the macro nutrients
13:55
Speaker 1: for a number of reasons.
13:57
Speaker 3: It seems so like judgment. That seems so judgement.
14:00
Speaker 2: All right, convince me, convince me. I love carbonydrate, so
14:03
Speaker 2: I'm not really sure that I believe you.
14:05
Speaker 1: That's why they're interesting. Carbohydrates are really simple. You know,
14:10
Speaker 1: they're sugars, or they're sugars that are stuck to other sugars.
14:13
Speaker 1: It's like building a tower of lego blocks with the
14:15
Speaker 1: same shape, you know, all the way up. That's all
14:17
Speaker 1: you can do. Fats are somewhat similar. Carbohydrates and fats
14:22
Speaker 1: both stores of energy get broken down into energy which
14:26
Speaker 1: your body can use, and only two things water and
14:29
Speaker 1: carbon dioxide. So you completely excrete all the product of
14:33
Speaker 1: fat metabolism and carbohydrate metabolism by breathing and I guess
14:38
Speaker 1: peeing if you want to get rid of the excess water. Now,
14:40
Speaker 1: proteins are really complicated, So you go back to high
14:45
Speaker 1: school biology, you'll remember that proteins are comprised of these
14:49
Speaker 1: different amino acids, and there are really kind of twenty
14:53
Speaker 1: common amino acids that humans use. There are twenty two total.
14:56
Speaker 1: If you really search, you can find an extra two
14:58
Speaker 1: amino acids, but they're basically twenty amino acids, which are
15:01
Speaker 1: the different lego pieces that you can put together in
15:04
Speaker 1: any different combination you want to make any different protein
15:07
Speaker 1: you want, which is why proteins make up all of
15:11
Speaker 1: the stuff of our body. You know, your skin is protein,
15:13
Speaker 1: and your muscle is protein, and your hair is protein
15:15
Speaker 1: or products of protein, and it's incredibly complicated. And when
15:20
Speaker 1: you break down protein, you don't just get water and
15:23
Speaker 1: carbon dioxide. You get water, carbon dioxide and other stuff
15:28
Speaker 1: amino acids and ammonia, which is highly toxic, and that's
15:33
Speaker 1: something that we might have to come around to now.
15:35
Speaker 1: Of course, your body has ways to deal with that
15:37
Speaker 1: toxic stuff. We can metabolize protein, but it's pretty interesting.
15:43
Speaker 1: The other interesting thing about all these amino acids is
15:46
Speaker 1: that nine of them are what are called essential, and
15:50
Speaker 1: essential amino acids are amino acids that you cannot synthesize
15:54
Speaker 1: in your own body from any chemicals that exist naturally
15:58
Speaker 1: in your body or from other amino ass acids that
16:00
Speaker 1: you take in. In other words, these are amino acids
16:03
Speaker 1: that if you don't get them into your body, you
16:06
Speaker 1: will die. Nine of them are like that. So nine
16:09
Speaker 1: amino acids. Nine components of protein act similarly to vitamins,
16:14
Speaker 1: such that if you didn't have enough, and you don't
16:16
Speaker 1: need a ton, but if you didn't have enough, it
16:18
Speaker 1: would be fatal. And that's not the case for carbohydrates
16:21
Speaker 1: or fats. In general. You need some carbohydrate and some
16:24
Speaker 1: fat to sustain life, but it doesn't particularly matter which
16:29
Speaker 1: one or which source. That's why they're so interesting, all right.
16:32
Speaker 3: So fine, they seem interesting.
16:35
Speaker 2: Another way to say this is that I could in
16:39
Speaker 2: principle live on carbohydrates and protein with almost no fat
16:44
Speaker 2: or very little fat. And I could also live on
16:47
Speaker 2: fat and protein with very little or no carbohydrates. But
16:51
Speaker 2: I could not live on carbohydrates and fat without some protein.
16:55
Speaker 1: That's absolutely right, And there is a condition pure protein malnutrition.
17:02
Speaker 1: So these are people who have adequate caloric intake from
17:06
Speaker 1: carbohydrates and potentially fats, but not enough protein. It's called
17:10
Speaker 1: quashy or core. But where you have seen it are
17:13
Speaker 1: those if you remember those old advertisements of this, like
17:17
Speaker 1: quote unquote starving kids in Africa with the big bellies.
17:21
Speaker 1: So that big belly is filled with a fluid leaking
17:24
Speaker 1: from the liver because there's no protein in the body
17:27
Speaker 1: to retain that fluid. It's called ascid's And that is
17:30
Speaker 1: not starvation, not pure starvation. It is protein specific starvation.
17:35
Speaker 1: So there is a disease syndrome associated with pure protein malnutrition.
17:39
Speaker 1: I will say that you also die if you only
17:41
Speaker 1: eat protein, and there are cases of this. You go
17:45
Speaker 1: into keto acidosis if you don't have any sugar or
17:49
Speaker 1: fat at some point, and this has been reported in
17:53
Speaker 1: some very rare people who have been living like exclusively
17:57
Speaker 1: on highly lean mind like rabbit meat. So there are
18:02
Speaker 1: people living in the wilderness who like only eate rabbits
18:05
Speaker 1: for thirty days or something, and you can actually die
18:07
Speaker 1: of that as well.
18:07
Speaker 3: Don't you think at that point you'd also have scurvy?
18:10
Speaker 1: You would almost certainly have scurvy, But I think it
18:12
Speaker 1: takes a bit longer.
18:13
Speaker 2: To get scurvy. Yeah, okay, we can do another episode
18:16
Speaker 2: on scurvy.
18:18
Speaker 1: Yeah, a lot of our time, certainly, not a lot.
18:21
Speaker 2: Of people have it, but if you have it, it's
18:23
Speaker 2: not good. Okay, So back to the product. Protein is
18:27
Speaker 2: a thing that we need. We need a good solid
18:32
Speaker 2: amount of because of these amino acids, particularly the nine
18:36
Speaker 2: amino acids. Is any type of protein going to give
18:40
Speaker 2: us the nine essential amino acids?
18:43
Speaker 1: Short answer is yes, we don't have to worry about
18:46
Speaker 1: this too too much, And I think this can transit
18:50
Speaker 1: provided you eat an adequate total amount of protein. Most
18:54
Speaker 1: stuff you're going to get out there is comprised of
18:56
Speaker 1: enough variation in amino acids that you'll cover your bases.
18:59
Speaker 1: But this leads to the I think central question that
19:02
Speaker 1: we're all asking ourselves. Certainly I am since I started
19:05
Speaker 1: writing down what I'm actually eating from day to day,
19:07
Speaker 1: which is, wait a second, how much protein am I
19:11
Speaker 1: supposed to have? So Emily, I want to turn this
19:13
Speaker 1: to you. How much protein does the government say we
19:17
Speaker 1: need to have? And then I want to know how
19:19
Speaker 1: much protein you have?
19:22
Speaker 2: Okay, So I will tell you that I hate this
19:25
Speaker 2: question and I feel like it is the first question
19:27
Speaker 2: people are like, how much protein.
19:29
Speaker 3: Should I have?
19:31
Speaker 2: And I think that that question is like fundamentally really
19:34
Speaker 2: really flawed.
19:35
Speaker 3: So I will tell you what the government says.
19:36
Speaker 2: The government has a like recommended daily allowance, and it
19:40
Speaker 2: is zero point eight grams per kilogram per day.
19:44
Speaker 3: So that's about a.
19:45
Speaker 2: Third of a gram of protein per pound. So if
19:48
Speaker 2: you're a person who weighs like one hundred and eighty pounds,
19:51
Speaker 2: that would say you should have about sixty five grams
19:54
Speaker 2: of protein a day. That is actually not that much,
19:58
Speaker 2: and most people in the U get that amount. So
20:02
Speaker 2: I looked in preparation for this discussion, I looked at
20:05
Speaker 2: the en Haines data, which is a national longitudinal representative study,
20:10
Speaker 2: and they ask people about their diet and they calculate
20:12
Speaker 2: their protein. And the average woman has studies getting about
20:15
Speaker 2: seventy five grams of protein to day. The average man's
20:18
Speaker 2: getting a little over one hundred. So that is actually
20:21
Speaker 2: plenty of protein based on the government recommendations.
20:24
Speaker 1: And that recommendation, correct me if I'm wrong, is essentially
20:27
Speaker 1: based on these calculations of like, if you fall below
20:32
Speaker 1: this for a sustained period of time, you will actually
20:34
Speaker 1: like get into worse health or potentially have malnutrition.
20:38
Speaker 2: Yeah, so this comes out of the recommended daily allowance,
20:41
Speaker 2: which is a number that the government has designed in
20:46
Speaker 2: order to tell basically an institutional like if you had
20:50
Speaker 2: an institutional population, you know, you were like feeding people
20:53
Speaker 2: at a jail, and you were controlling like how many
20:56
Speaker 2: calories you would have available, and how much protein and
21:00
Speaker 2: how many micronutrients they have, these numbers of which you know,
21:04
Speaker 2: this is like this is one of them. And the
21:07
Speaker 2: idea is that this is going to like this would
21:11
Speaker 2: be enough for people to be healthy and like lead
21:15
Speaker 2: a healthy institutional lifestyle.
21:18
Speaker 3: That's the basic idea.
21:19
Speaker 1: Let's say I want to do a little bit more
21:21
Speaker 1: than be a healthy a healthy member of some institution.
21:25
Speaker 2: All right, let's sort of say like sixty five grams
21:27
Speaker 2: if you're a person in one hundred and eight pounds,
21:29
Speaker 2: like sixty five sixty grams of protein to day is
21:31
Speaker 2: actually not that much. So a cup of Greek yogurt
21:36
Speaker 2: has like twelve grams of protein. Chicken breast, a sort
21:39
Speaker 2: of standard sized chicken brass, has probably thirty grams of protein.
21:43
Speaker 2: So this is like, you know, you could get to
21:45
Speaker 2: sixty grams of protein pretty easily, which is not surprising
21:48
Speaker 2: that most people are there.
21:51
Speaker 3: The question then is like is that enough?
21:53
Speaker 2: And this is the discussion, like sort of out in
21:56
Speaker 2: the world where people are telling you look or people influencers,
22:00
Speaker 2: you know, fitness enthusiasts will say, you know, point a
22:04
Speaker 2: grams per kilogram is nowhere near enough. A number that
22:06
Speaker 2: often gets thrown around is like one gram per pound
22:10
Speaker 2: of body weight. So that would mean for someone of
22:12
Speaker 2: one hundred and eighty pounds, rather than take having sixty
22:14
Speaker 2: five grams a day, you should have one hundred and
22:16
Speaker 2: eighty grams a day. And that's a lot more than sixty. Obviously,
22:20
Speaker 2: that is a ton ton of protein. Yeah, it's a
22:23
Speaker 2: ton of protein.
22:24
Speaker 3: And I think the core question for people is, like,
22:26
Speaker 3: is that something I need to be prioritizing in part
22:29
Speaker 3: because like, that's work. Like to particularly to get.
22:32
Speaker 2: One hundred and eighty grams of protein while also not
22:36
Speaker 2: consuming like four hundred billion calories is challenging. Right, When
22:41
Speaker 2: people say get all this protein, they don't mean like
22:43
Speaker 2: and also get an equivalently larger number of carbohydrates in fat.
22:46
Speaker 2: They mean like, prioritize protein relative to those and that
22:50
Speaker 2: takes effort.
22:51
Speaker 1: Right, So if we are pursuing that kind of goal,
22:54
Speaker 1: and I tried it a little bit, I tried to
22:56
Speaker 1: think to myself and it does take planning. It's like, okay, wait,
22:59
Speaker 1: what am I going to have for lunch? And how
23:01
Speaker 1: am I going to get all this protein in? And
23:03
Speaker 1: you're looking for foods that are, you know, how per
23:06
Speaker 1: calorie have a lot of protein in them. And one
23:09
Speaker 1: rule I sort of saw that does work out fairly
23:12
Speaker 1: nicely is that if you take the grams of protein
23:14
Speaker 1: in a food and you multiply it by ten and
23:17
Speaker 1: that's more than the calories in the food, then it's
23:20
Speaker 1: like a high protein food. So for example, if you
23:23
Speaker 1: know there's ten grams of protein in a one hundred
23:25
Speaker 1: calorie portion, then that's a high protein food. And that
23:30
Speaker 1: works out to about forty percent protein per calorie, which
23:34
Speaker 1: is like that seems about right to me, But it's
23:37
Speaker 1: actually quite hard to even all those protein bars and
23:40
Speaker 1: stuff at costco like don't necessarily get to that level.
23:46
Speaker 3: Yeah, I think so, I think we should talk about
23:47
Speaker 3: how to get to that level.
23:48
Speaker 2: But I think we should also we should start by
23:50
Speaker 2: talking about, like what are the scenarios in which you
23:53
Speaker 2: would want to get to a higher level of protein. So,
23:56
Speaker 2: because I think again getting back like the question of
24:00
Speaker 2: than asking what is the right amount of protein, I
24:02
Speaker 2: think the first question people should say is like what
24:04
Speaker 2: is their goal?
24:05
Speaker 1: What is your goal?
24:06
Speaker 3: And I think there's a few different goals people have.
24:08
Speaker 1: Let me give you my goal. I want to know
24:11
Speaker 1: about building muscle. I want to I'm in my forties
24:15
Speaker 1: and I'm looking to get a little.
24:17
Speaker 2: Bit mid mint to late forties, Perry, you.
24:21
Speaker 1: Know who's counting. I'm in my mental late forties and
24:26
Speaker 1: I'm hitting the gym, and the guys there are I
24:29
Speaker 1: will say, very into protein. So what's the evidence there
24:35
Speaker 1: is protein supplementation good for muscle? It makes sense, right,
24:37
Speaker 1: Protein blocks supplement is the building block of muscle. That's
24:40
Speaker 1: what I learned in biology.
24:43
Speaker 2: This is the place where I think the evidence the
24:44
Speaker 2: sort of most clear that protein is key to building muscle.
24:49
Speaker 2: And if you are either a person in your mid
24:52
Speaker 2: to late forties who is looking to build some muscle,
24:54
Speaker 2: or and I think this is important if you're an
24:55
Speaker 2: older person who is trying to maintain muscle mass. Hard
24:59
Speaker 2: to build my muscle when you're you know, in your
25:01
Speaker 2: sixties and seventies, but you can maintain muscle. It's really
25:03
Speaker 2: important for like not falling down. And we have a
25:07
Speaker 2: fair amount of good evidence, particularly in these older populations
25:10
Speaker 2: that having a higher amount of protein relative to these
25:15
Speaker 2: you know, recommendations. But having more protein can maintain muscle
25:20
Speaker 2: mass and can improve people's health.
25:24
Speaker 3: But and this is I.
25:25
Speaker 2: Think like the most important thing. It is not just
25:28
Speaker 2: eating the protein. You also have to exercise. Right, Like
25:32
Speaker 2: we talk about the protein, like you eat the protein
25:34
Speaker 2: and then it like magically turns into muscle.
25:37
Speaker 3: That's not how it works.
25:38
Speaker 2: You eat the protein and you do resistance training some
25:41
Speaker 2: kind of exercise, and those together make more muscle. So
25:44
Speaker 2: if you're gonna you perry, you are going to go
25:46
Speaker 2: to the gym and stand there and watch the other
25:48
Speaker 2: guys while you eat a protein bar. Nothing will happen
25:52
Speaker 2: except you will just be a person who's eating a
25:54
Speaker 2: protein bar.
25:55
Speaker 1: It's such a good point. And I will say that biologically,
26:00
Speaker 1: when your body breaks down that protein into its constituent
26:02
Speaker 1: amino acids, there are two pathways that those amino acids
26:06
Speaker 1: can go down. One pathway is those amino acids get
26:08
Speaker 1: incorporated into a new protein like a muscle fiber. The
26:12
Speaker 1: other pathways that those amino acids gets further broken down
26:15
Speaker 1: into sugar and you get calories out of it, and
26:18
Speaker 1: your body is more than willing to get calories out
26:21
Speaker 1: of anything you put into it if you're not using
26:23
Speaker 1: it for some other purpose, So absolutely you got to
26:26
Speaker 1: actually use it. Do you have any opinion about this,
26:28
Speaker 1: like should I be doing protein supplementation before workout after workout?
26:33
Speaker 1: Is that superstition?
26:35
Speaker 3: I have a lot of feelings about that.
26:38
Speaker 2: In general, it doesn't matter so most people, it actually
26:43
Speaker 2: doesn't matter much in the data. This is a place
26:46
Speaker 2: where we have pretty good data because it's actually very
26:48
Speaker 2: easy to study people who are doing endurance sports or
26:51
Speaker 2: any kind of sports, because they love to be studied,
26:54
Speaker 2: and they're looking to optimize their protein intake in various
26:56
Speaker 2: ways because they're lunatics. When you look at that those populations,
27:02
Speaker 2: it doesn't matter what time of what. When you had
27:05
Speaker 2: people tell you have to have your protein shape within
27:07
Speaker 2: like thirty minutes after a workout is just not supported
27:09
Speaker 2: by the evidence.
27:10
Speaker 3: You want to kind of have it within a day.
27:12
Speaker 2: But if we're thinking about over the course of a day,
27:15
Speaker 2: it doesn't that whether you get all your protein, even
27:18
Speaker 2: like all at once versus in multiple chunks, doesn't seem
27:21
Speaker 2: to impact the performance.
27:24
Speaker 1: That's been something people have been worried about for a
27:26
Speaker 1: long time. Was this idea that there's like protein overflow,
27:29
Speaker 1: like if you took too much in at once, you
27:32
Speaker 1: wouldn't use it and the excess wouldn't get used appropriately.
27:35
Speaker 1: Not much evidence for that.
27:37
Speaker 2: Not much evidence for that, certainly over a course of
27:39
Speaker 2: like a twenty four hour period.
27:41
Speaker 1: I want to move on from muscle because there's some
27:43
Speaker 1: other interesting protein stuff out there, But before we do,
27:45
Speaker 1: we should probably talk about the specialist of the amino acids,
27:49
Speaker 1: which is leucine. So leucine is this amino acid that,
27:55
Speaker 1: unlike all of its nineteen brethren that found in protein,
28:01
Speaker 1: has a signaling effect in muscle. So in your body,
28:04
Speaker 1: there are all sorts of signals that your body reads
28:07
Speaker 1: to know how to grow and how to change, And
28:09
Speaker 1: muscle has a signaling receptor for leucine. And it seems
28:13
Speaker 1: like lucine may be the thing that muscle uses to
28:18
Speaker 1: know that there's a lot of protein around, right, Like,
28:20
Speaker 1: how does your muscle know it's safe to sort of
28:22
Speaker 1: build more muscle? And there's some evidence that the signaling
28:26
Speaker 1: molecule for muscle reading your nutritional status from a protein
28:30
Speaker 1: perspective is this particularly meino acid, leucine because of that,
28:35
Speaker 1: you see leucine supplement supplements out there. We've started to
28:39
Speaker 1: see a few loucine supplement studies in terms of muscle
28:43
Speaker 1: building with mixed results. But I wanted to bring it up.
28:47
Speaker 1: There's not a good natural source of lucine beyond anything
28:51
Speaker 1: else that has a lot of protein. So like chicken
28:53
Speaker 1: breast has plenty of leucine in it, beans have lucine,
28:57
Speaker 1: cottage she has lucine. Wherever you're getting your protein and
29:00
Speaker 1: you're getting your lucine. But supplementation is always different, right
29:02
Speaker 1: because now we're talking about something that's processed. You're getting
29:05
Speaker 1: super physiologic doses, and we're starting to see that. Have
29:09
Speaker 1: you had people coming to you talking to you about
29:11
Speaker 1: lucine yet or is this still on the edge.
29:13
Speaker 2: I think this is still on the edge, and people
29:15
Speaker 2: ask me a lot about protein in general.
29:16
Speaker 3: But even it's interesting.
29:18
Speaker 2: So I consume, as people will learn if they listen
29:21
Speaker 2: to this podcast more. I consume a lot of endurance
29:24
Speaker 2: sports content and even there you will see some discussions
29:29
Speaker 2: of sort of lucine supplementation, but I think not as
29:33
Speaker 2: much as you would get it. Like body, My guess
29:35
Speaker 2: is in the body building space. This gets a lot
29:37
Speaker 2: of discussion because the core there is muscle building.
29:41
Speaker 1: Yeah, yeah, so keep an eye out for that. We
29:44
Speaker 1: might end up talking about lucine again in the future
29:48
Speaker 1: if we ever get to wrap a micin and aging.
29:51
Speaker 1: But speaking of aging the aging brain, so I'm willing
29:56
Speaker 1: to concede that to build muscle you probably need to
29:59
Speaker 1: have adequate prote ten intake. You probably need to have
30:04
Speaker 1: are there recommended? Before we move on? Sorry, can you
30:06
Speaker 1: give me a number like I is my one hundred
30:09
Speaker 1: and fifty that I had that day? Is that a
30:12
Speaker 1: good target for me? Clearly more than the sixty I
30:15
Speaker 1: had when I just state mac and cheese.
30:16
Speaker 2: Yeah, I mean, I think a lot of a number
30:18
Speaker 2: that a lot of people talk about is two grams
30:21
Speaker 2: per kilogram or one point six grams per kilograms, So
30:23
Speaker 2: that would put people in more like you know, somebody
30:27
Speaker 2: like you, more like one.
30:28
Speaker 1: Hundred little less than a gram per pound.
30:30
Speaker 2: Little less than a graand per pound. A grad per
30:32
Speaker 2: pound is a lot of protein. I think many of
30:34
Speaker 2: these things go for one point six.
30:36
Speaker 1: All right, So I need to find some good ways
30:39
Speaker 1: to get me today. Yeah, all right, So let's talk
30:42
Speaker 1: about brains a lot of studies of protein supplementation have
30:46
Speaker 1: focused on more older people, elderly people, particularly the frail elderly,
30:51
Speaker 1: with some interesting results. One I pulled out of the
30:55
Speaker 1: ether here a little bit was a trial called the
30:57
Speaker 1: pro Muscle Trial smallest set sixty five frail elderly people
31:02
Speaker 1: who were randomized to get supplementation with milk protein. Not
31:08
Speaker 1: sure if milk protein is different than just way protein,
31:11
Speaker 1: but it was described as milk protein thirty grams a
31:14
Speaker 1: day in two doses versus just a placebo Emily, you'll
31:18
Speaker 1: be happy to hear they both groups got resistance training.
31:21
Speaker 3: You have to do resistant Okay, of.
31:23
Speaker 1: Course, yes they they both got resistance training. But the
31:27
Speaker 1: group randomized to the protein supplements at the end of
31:31
Speaker 1: the trial, which was a couple months, had one point
31:34
Speaker 1: three kilograms additional lean body mass and had a one
31:39
Speaker 1: point improvement on the short physical performance battery, which is
31:42
Speaker 1: sort of a variety of exercise based tests. So not
31:45
Speaker 1: like amazing, but you know, a nice randomized trial we
31:49
Speaker 1: like to see that seem to work. No particular difference
31:54
Speaker 1: in their cognition or.
31:56
Speaker 2: Memory that would be consistent with the rest of my
31:59
Speaker 2: reading of this, which is that the impacts on dementia
32:03
Speaker 2: and so on are small or zero. I think what
32:07
Speaker 2: sort of interesting and nuanced about that? Is my sense
32:12
Speaker 2: from other pieces of data, is it staying like active
32:16
Speaker 2: and engaged with the world is very good for your cognition.
32:20
Speaker 2: So if consuming more protein and doing some resistance training
32:24
Speaker 2: makes you able to walk around more and you know,
32:27
Speaker 2: pick up your grandkids and not be bed ridden, that
32:29
Speaker 2: could actually be good for your cognition, just because it
32:32
Speaker 2: enables activities which are themselves good for cognition. So is
32:36
Speaker 2: there a mechanistic effect through the protein affecting your brain.
32:39
Speaker 3: Maybe not. Is there a causal effect because it goes
32:42
Speaker 3: through these other pathways.
32:43
Speaker 1: Maybe there is, I like the off target effects, the
32:45
Speaker 1: knockout effects. Let's move on to the third scenario that
32:49
Speaker 1: I like to think about when I'm thinking about protein intake,
32:53
Speaker 1: which is can of helping lose weight. So protein I
32:58
Speaker 1: have been told is good for satiety. It's a little
33:02
Speaker 1: harder to break down, certainly than like a simple carbohydrate
33:05
Speaker 1: which is going to give you that boost of energy
33:07
Speaker 1: and then begone and then you're hungry five minutes later.
33:10
Speaker 1: So I can make a biologic plausibility argument that proteins
33:15
Speaker 1: will help you lose weight. Do you think they really
33:17
Speaker 1: does A higher protein diet, I should say, really help
33:20
Speaker 1: you lose weight, all else being equal, calorically.
33:22
Speaker 2: Speaking, look, maybe a little bit in the short term.
33:27
Speaker 2: In a very core fact about diets is that they
33:32
Speaker 2: mostly don't work in the long term. Most dietary changes
33:36
Speaker 2: can cause people to lose some weight in the short term,
33:38
Speaker 2: and then mostly they gain it back in the slightly
33:41
Speaker 2: longer term. To the extent that protein causes you to
33:46
Speaker 2: feel more full and makes it easier for you to
33:48
Speaker 2: stick to the diet, then okay, that could make it
33:52
Speaker 2: more effective, but this is not a game changer.
33:54
Speaker 1: I mean.
33:54
Speaker 2: And I also find this discussion at this point like
33:58
Speaker 2: if people want to lose significt get amount of weight,
34:01
Speaker 2: they should go on a GLP one And that's just
34:04
Speaker 2: what it is.
34:06
Speaker 1: I tend to agree with you. I think all the
34:09
Speaker 1: successful diets tend to be transient, and they all share
34:13
Speaker 1: one thing in common, which is that it makes it
34:15
Speaker 1: harder to eat food. And so you know, if you
34:18
Speaker 1: look at Atkins or something, you know these keto diets,
34:21
Speaker 1: like it just is harder. You have to think more
34:23
Speaker 1: about what you eat. You have to plan a little
34:25
Speaker 1: bit more, and I think high protein diets. My personal
34:29
Speaker 1: experience as I've started to look around and like get
34:32
Speaker 1: more protein into the food I eat is the same thing.
34:34
Speaker 1: I'm like, oh no, I can't eat that. You know
34:35
Speaker 1: that those chips are not you know, there's no protein
34:39
Speaker 1: in there, and I need to find a source that
34:40
Speaker 1: gets my protein. So I think whenever you make it
34:42
Speaker 1: difficult for people to eat, yeah, protein chips would be
34:46
Speaker 1: you know, but if you make it difficult for people
34:49
Speaker 1: to eat, you're always going to lose some weight. I mean,
34:51
Speaker 1: I will say there was a just to pull out
34:53
Speaker 1: a randomized trial, you know, there is some evidence of
34:56
Speaker 1: weight loss. There is a twenty ten study which randomized
34:59
Speaker 1: and men with diabetes to a thirty five percent protein
35:02
Speaker 1: diet to it versus a fifteen percent protein diet. They
35:07
Speaker 1: were both calorie restricted. So that's that's another thing you
35:10
Speaker 1: have to account for. Like, as you said, Emily, if
35:12
Speaker 1: you eat more protein, but by eating more protein, you're
35:15
Speaker 1: eating thirty percent more calories, You're you're definitely not going
35:19
Speaker 1: to lose weight, right. But in this calorie equalized environment,
35:24
Speaker 1: the men who randomized to the protein that had about
35:27
Speaker 1: a three kilogram extra weight loss after four months. This
35:31
Speaker 1: is not impressive in a world that has GLP ones,
35:34
Speaker 1: I understand, but as we said, not everyone has access
35:37
Speaker 1: to GLP ones. Everyone has access to protein.
35:39
Speaker 3: We hope agreed.
35:40
Speaker 2: I will say there is an addendum here in the
35:43
Speaker 2: GLP one space, which is to the extent that people
35:45
Speaker 2: are on a GLP one, you know, that makes you
35:47
Speaker 2: eat less. And as we said at the top, protein continues.
35:52
Speaker 3: To be very important.
35:54
Speaker 2: And so to the extent that you are on a
35:57
Speaker 2: GLP one and trying to lose weight and do.
35:59
Speaker 3: Not want to lose muscle mass, you.
36:02
Speaker 2: Do need to prioritize getting a larger share of your
36:05
Speaker 2: calories from protein, because you basically want to keep your
36:08
Speaker 2: protein more similar to where it was and drop other things.
36:11
Speaker 2: And I think that can be a challenge for people
36:13
Speaker 2: when they're sort of not hungry and they just kind
36:16
Speaker 2: of don't want to eat anything. It's not just eating less,
36:19
Speaker 2: it's changing the balances of food.
36:22
Speaker 1: This is what I want to hear from you as
36:23
Speaker 1: we as we wrap this up. My wife has terminator
36:28
Speaker 1: vision for food, Like she can look at a plate
36:30
Speaker 1: of food and tell you, like, how many calories, how
36:33
Speaker 1: many grams are fat? How many grams of protein? I
36:35
Speaker 1: don't know if all women have this. I'm not sure
36:37
Speaker 1: if it's built in.
36:38
Speaker 3: We developed it.
36:39
Speaker 2: We've developed it all women in our in our mid
36:41
Speaker 2: to late forties. We developed this a long time ago,
36:43
Speaker 2: and we're retaining that skilled ye accurating a bike.
36:46
Speaker 1: Like I will, I will take a package that has
36:49
Speaker 1: the nutritional information and she will be able to do
36:51
Speaker 1: it. It's very impressive. I cannot do that. I know that. Intellectually.
36:55
Speaker 1: I'm like, oh, yeah, chicken, that's good. But let's say
36:59
Speaker 1: I decide, you know what I'm going to go for it.
37:01
Speaker 1: I'm going a gram per pound a lot of protein.
37:04
Speaker 1: I don't think I can make it. What are your
37:06
Speaker 1: tips for me? And maybe I'll make it even simpler?
37:11
Speaker 1: Is there any way to do this short of me
37:13
Speaker 1: buying in bulk some can of protein powder, whether it's
37:16
Speaker 1: weigh powder or soy powder or you know, wheature, whatever
37:19
Speaker 1: it is, and adding it to things and making shakes?
37:22
Speaker 1: Or can I do this with food as it exists
37:26
Speaker 1: in reality?
37:27
Speaker 3: So we term doesn't have a lot of protein, So don't.
37:30
Speaker 1: Vi weat gluten? Sorry weak gluten?
37:33
Speaker 3: Oh good lord? Okay?
37:34
Speaker 2: So uh So I will say I think for most people,
37:41
Speaker 2: if you are attempting to get something like a gram
37:44
Speaker 2: per pound of body weight, which again is a lot
37:48
Speaker 2: even for a pretty small person, is a lot, you
37:51
Speaker 2: will need to use some kind of protein powder, something
37:57
Speaker 2: some kind of thoughtful of pro coach, which probably involves
38:01
Speaker 2: supplementation with not real food. You know, think about like
38:05
Speaker 2: a protein shake, you know why. Protein shake probably has
38:08
Speaker 2: can you know, can have twenty five grams of protein.
38:12
Speaker 2: That's like a whole chicken breast pretty much. And it's
38:14
Speaker 2: just hard for people to consume enough whole foods to
38:18
Speaker 2: get that kind of protein without also adding a lot
38:21
Speaker 2: of fat and carbohydrates. So I will say, you asked
38:24
Speaker 2: me at the top, how much protein do you eat
38:25
Speaker 2: in a day? I do eat about a gram of
38:28
Speaker 2: protein per pound of body weights. That's about one hundred
38:31
Speaker 2: and thirty ish grams of protein a day. And the
38:33
Speaker 2: only way that I can achieve that is by consuming
38:37
Speaker 2: like a large protein shake in the morning.
38:39
Speaker 1: And what is the protein? Is it way protein?
38:41
Speaker 2: Typically that it's just way breakenth yeah, just way protein.
38:45
Speaker 2: All right, all right, So now here's my question for you.
38:48
Speaker 2: We have revealed that I'm a crazy person who drinks,
38:50
Speaker 2: who eat, consumes a lot of protein, and I should
38:52
Speaker 2: say I just I want to say. The reason that
38:54
Speaker 2: I consume a lot of protein, getting back to these
38:56
Speaker 2: questions of like why are you doing this, is that
38:58
Speaker 2: I take myself infinitely too seriously with sports. I'm like
39:02
Speaker 2: a pretend elite athlete, a person who pretends to be
39:05
Speaker 2: an athlete, and I so I run a lot and
39:08
Speaker 2: I consume a lot of protein in service of that.
39:11
Speaker 3: So that is my that is my reasoning.
39:13
Speaker 1: So not for everyone, but not for people.
39:16
Speaker 2: Like you people crazy people. So here's my question. Can
39:21
Speaker 2: you have too much protein? And what would happen?
39:24
Speaker 1: So yes, as a medical doctor, yes you can. So
39:29
Speaker 1: a couple of things.
39:30
Speaker 3: You're a kidney doctor, I'm a kidney doctor, specifically good.
39:34
Speaker 1: Particular yes, yes, no, this is this is certainly right
39:37
Speaker 1: up my alley. So so yeah, I mean, first of all,
39:39
Speaker 1: if you only had protein to the exclusion of all
39:41
Speaker 1: other macro nutrients, you die. We talked about this, very
39:44
Speaker 1: difficult to do unless you're only eating rabbit meat, so
39:47
Speaker 1: I'm not too worried about that. But from a kidney standpoint,
39:50
Speaker 1: the data is quite compelling that more protein intake puts
39:56
Speaker 1: more stress on the kidneys. And I'm pausing on the
40:00
Speaker 1: word stress, because what exactly do I mean by that.
40:04
Speaker 1: We measure kidneys filter the blood, and we can measure
40:07
Speaker 1: the rate at which they filter the blood in milli
40:10
Speaker 1: liters per minute, and for a healthy person it's about
40:12
Speaker 1: one hundred millimeters per minute, which means that you're cycling
40:15
Speaker 1: through your entire blood volume dozens and dozens of times
40:19
Speaker 1: a day with your kidneys cleaning that, which is great.
40:22
Speaker 1: Acute protein intake increases that filtration rate so from one
40:27
Speaker 1: hundred to one hundred and ten one hundred and twenty
40:30
Speaker 1: mili liters per minute, and you might think great, you know,
40:33
Speaker 1: like that's more filtration now. Of course, the reason your
40:36
Speaker 1: kidneys are doing that is because, unlike carbohydrates and fat,
40:40
Speaker 1: proteins are metabolized into ammonia, and ammonia needs to be excreted.
40:45
Speaker 1: It's excreted as this thing called urea, which is where
40:48
Speaker 1: urine gets its name. But urea is the way that
40:51
Speaker 1: urine excretes ammonia. You have to increase filtration to get
40:54
Speaker 1: rid of the ammonia load. There is data in people
40:58
Speaker 1: with kidney disease that low protein diets protect the kidneys
41:03
Speaker 1: in the long term. That's been well established. In fact,
41:08
Speaker 1: up until about ten years ago, we would routinely recommend
41:11
Speaker 1: people with kidney disease to decrease their protein intake for
41:14
Speaker 1: just this reason. Nowadays I don't do that, in part
41:19
Speaker 1: because of what we've talked about. I'm also worried about
41:22
Speaker 1: their muscle mass and their health and their ability to
41:25
Speaker 1: move around and get exercise, and I don't like telling
41:27
Speaker 1: people to restrict, but I certainly don't tell my patients
41:30
Speaker 1: with kidney disease to like supplement protein. And the reason
41:35
Speaker 1: it seems that your kidneys are better off when they're
41:39
Speaker 1: not stressed like this, when they're not forced to increase filtration,
41:43
Speaker 1: is that there's a finite amount of tread on the tire,
41:47
Speaker 1: and at least for people with underlying kidney disease, forcing
41:51
Speaker 1: them to run at one hundred and ten percent one
41:53
Speaker 1: hundred and twenty percent capacity just stresses them out more
41:57
Speaker 1: and you lose kidney function faster. What I don't know
42:01
Speaker 1: if is that's true for people without any kidney disease.
42:04
Speaker 1: We don't have long term data a very high protein
42:07
Speaker 1: intake to suggest if that alone in the absence of
42:10
Speaker 1: other diseases is going to affect kidney function, but it
42:13
Speaker 1: clearly does in people with underlying kidney disease.
42:15
Speaker 2: I think the other piece of the we will never
42:18
Speaker 2: know the answer to your last question, I think because
42:20
Speaker 2: the kind of people who are consuming very high amounts
42:23
Speaker 2: of protein are also very different, correct, mostly healthier, but
42:27
Speaker 2: just very different in other ways. So we would never
42:29
Speaker 2: really be able to compare you know, the people who
42:32
Speaker 2: having two and a half grams of protein per kilog
42:35
Speaker 2: like these very high levels to lower levels, because you're
42:38
Speaker 2: just going to.
42:38
Speaker 3: Find they're different in all kinds of other all kinds
42:40
Speaker 3: of other ways.
42:40
Speaker 1: Yeah, there's a very hypothetical other risk which I will
42:44
Speaker 1: just say that protein does have signaling effects, including that
42:49
Speaker 1: lucine thing that signals muscles to grow. In the context
42:53
Speaker 1: of muscle, we like growth, but there are other parts
42:55
Speaker 1: of the body that we don't want to grow. And
42:59
Speaker 1: so yourself in your body are kind of constantly under
43:02
Speaker 1: balanced signals saying grow, divide like fill in this space,
43:06
Speaker 1: you got to cut like heel at that kind of stuff.
43:09
Speaker 1: Muscles get bigger, you know, fat cells grow like all
43:12
Speaker 1: those kind of things, and signals that say no no, no,
43:15
Speaker 1: stay quiet, stay where you are. We know when those
43:18
Speaker 1: signals get out of hand and excessive growth signaling occurs
43:21
Speaker 1: that that is a step towards cancer development and lucine.
43:25
Speaker 1: This particular amino acid stimulates a molecule called m tour,
43:31
Speaker 1: a million target of wrapamycin, which is a known cancer
43:37
Speaker 1: promoting chemical in the blood. Now it also promotes muscle growth.
43:43
Speaker 1: So and there are usually there are many steps to
43:46
Speaker 1: getting cancer beyond just like, oh, your level of M
43:49
Speaker 1: tour might be a little bit too high. So I'm
43:51
Speaker 1: not as worried about this as I am about kidney
43:53
Speaker 1: function and very high protein intake. But you know, for
43:55
Speaker 1: interest of completeness, we should say that growth in and
43:59
Speaker 1: of itself is not universally a good thing. Okay, that
44:03
Speaker 1: is a ton of information about protein. Let's let's wrap
44:06
Speaker 1: this up, Emily, protein smash or pass?
44:12
Speaker 3: I think this question is unfair.
44:13
Speaker 2: You need protein for life, so in that sense, I
44:16
Speaker 2: would say I'm going to smash it as an essential
44:20
Speaker 2: element of not being did I will say if the
44:23
Speaker 2: if the question is do I smash getting even more
44:28
Speaker 2: protein than you're getting now, I think.
44:30
Speaker 3: For most people I'm a pass on that. How about you.
44:35
Speaker 1: I'm I think a soft smash on this question of
44:38
Speaker 1: getting extra protein. You know, I think probably we should
44:42
Speaker 1: be more cognizant of the protein we take in. If
44:45
Speaker 1: we can get some extra protein, especially if we're replacing
44:48
Speaker 1: carbs in our diet, I'm down for that certainly. I
44:53
Speaker 1: think my one concern actually is that we really should
44:56
Speaker 1: be getting as much protein as possible from plant based
44:58
Speaker 1: sources so we don't tank our fiber intake, which is
45:02
Speaker 1: something we'll talk about in future episodes, especially when we
45:05
Speaker 1: look at the arising incidents of colon cancer. So cautious smash,
45:09
Speaker 1: but you don't have to go crazy about it.
45:11
Speaker 2: I feel like you're putting too many caveats into your smashes.
45:15
Speaker 2: We have to be a committed Perry in future episodes.
45:19
Speaker 2: Commit to smash your pass. There's a soft smash. All right, Fine,
45:24
Speaker 2: that's it for protein your mail bag Question of the
45:27
Speaker 2: week after the Break.
45:33
Speaker 4: Hi, Emile and Perry. My name is Natalie and I'm
45:35
Speaker 4: from Boston. Have been listening to the podcast and I
45:38
Speaker 4: heard you say that there's a lack of evidence on
45:40
Speaker 4: the efficacy of shockwave therapy. I've received this treatment a
45:43
Speaker 4: couple of times. For instances of tendonosis, and I was
45:47
Speaker 4: really pleasantly surprised. Of course, I'm willing to accept the
45:50
Speaker 4: possibility of the placebo effect, but my curse research of
45:53
Speaker 4: the literature did turn up a few studies that seem
45:56
Speaker 4: to support shockwave treatment. I would love to hear your
45:59
Speaker 4: thoughts on this. Thank you so much. Hi.
46:03
Speaker 3: Shockwave therapy.
46:04
Speaker 2: Yes, so, I have spent a lot of personal time, Perry,
46:08
Speaker 2: looking into this because I had a hamstring injury, hamstring tendinopathy,
46:14
Speaker 2: and I was told that shockwave therapy would help for
46:16
Speaker 2: those of you who are not you know, deep in
46:18
Speaker 2: the well of this activity. What this involves, at least
46:22
Speaker 2: in the sports context, is somebody taking a probe and
46:26
Speaker 2: some gel and delivering like acoustic waves into your tissue.
46:31
Speaker 2: It's quite uncomfortable, and the idea is that it like
46:35
Speaker 2: boosts your cell metabolism and generates better repair. I will
46:40
Speaker 2: say I did look into the data before I did this,
46:43
Speaker 2: and there is some reasonable randomized data suggesting that this
46:48
Speaker 2: improves healing speed in some tendonopathy related injuries, things like
46:54
Speaker 2: achilles tennis elbow rotator, actually your rotator cuff, Perry, it
47:00
Speaker 2: might help with that and I will say really helped
47:03
Speaker 2: with my hamstring, although it's very painful. Like there's a
47:06
Speaker 2: person doing this and they're like, what's your pain level.
47:08
Speaker 3: I was like, oh, it's like a four.
47:09
Speaker 2: He's like great, we're going for a seven, and then
47:11
Speaker 2: they just like turn it up until you're like, ah.
47:15
Speaker 1: Just compared to that, my hamstring feels great.
47:18
Speaker 2: Exactly afterwards, you're like, oh, thank god it's over. So
47:21
Speaker 2: a little bit of positive evidence on this.
47:24
Speaker 1: Yeah, we use it for kidney stones. Actually, I mean
47:26
Speaker 1: this is sort of different, but you know, for small
47:29
Speaker 1: enough kidney stones, you can send the shock weaves in
47:31
Speaker 1: and they kind of break up like an opera singer
47:34
Speaker 1: shattering a glass with her voice, and then you pass
47:37
Speaker 1: the little pieces out, which is I guess better than
47:40
Speaker 1: going up and retrieving them yourselves. Do you want to
47:43
Speaker 1: know a little interesting physics?
47:45
Speaker 3: Yes, always so.
47:48
Speaker 1: An ellipse has two fox si. That's like how you
47:51
Speaker 1: define the ellipse, Like two focuses two points inside the ellipse,
47:54
Speaker 1: and every point along the outer edge of the ellipse
47:56
Speaker 1: is equidistant from like the sum to the distance between
48:00
Speaker 1: those focia is constant. That's what defines an ellipse. Okay, wait,
48:03
Speaker 1: any time anything that goes through one focus bounces off
48:08
Speaker 1: the edge of the ellipse and will go through the
48:10
Speaker 1: other focus. And so for extra corporeal shockwave lithotripsy, they
48:15
Speaker 1: put the sound emitting device, the ultrasound device, at one
48:19
Speaker 1: focus of the ellipse, and then they curve the ellipse
48:24
Speaker 1: that it's in. It's like a half ellipse, a shell,
48:26
Speaker 1: so that's that sound bounces off and all of it
48:30
Speaker 1: gets focused into the other focus of the ellipse, which
48:33
Speaker 1: is somewhere inside your body. Isn't that kind of neat?
48:36
Speaker 2: That is incredibly interesting and physics is very neat, I
48:42
Speaker 2: think no. Okay, So one question I think maybe people
48:44
Speaker 2: have about the shockwave therapy is like, is this just
48:47
Speaker 2: place ebo? Because of course we know the placebo effect
48:50
Speaker 2: is one of the best effects, and it's hard to
48:53
Speaker 2: know if something is real or sham. But actually, in
48:57
Speaker 2: a lot of these studies of shockwave therapy they do
48:59
Speaker 2: placebo sham shockwave therapy on people. I'm not really sure
49:04
Speaker 2: how that would be involved and is it less painful?
49:07
Speaker 2: So we always have to be careful about placibo effects.
49:09
Speaker 2: On the other hand, my hamstring feels much better, So
49:12
Speaker 2: I guess I don't care.
49:13
Speaker 3: Why is my fundamental answer? All right, that's it for
49:17
Speaker 3: this week.
49:17
Speaker 2: Join us next week when we'll ask what's the deal
49:20
Speaker 2: with continuous glucose monitors? Wellness Actually is produced in association
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49:27
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49:29
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49:59
Speaker 3: We'll let the influencers have the last word.
50:02
Speaker 5: This is why I'm jacked and you're not. It's because
50:05
Speaker 5: I eat meals like this round beef and whole eggs,
50:10
Speaker 5: pure protein and healthy fats, zero carbohydrates. This is what
50:15
Speaker 5: I wish fat people understood if they just cut out
50:18
Speaker 5: carbohydrates for two weeks. I'm talking zero grams to twenty
50:22
Speaker 5: grams of carbs per day. They would lose ten pounds instantly.
50:27
Speaker 1: It's that easy.