High Protein Low Carbohydrate Diets: Targeting Who Benefits

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High Protein Low Carbohydrate Diets Targeting
Who Benefits? Dr Manny Noakes Senior Research
Dietitian CSIRO Clinical Research Unit
Health Sciences and Nutrition
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Obesity Epidemic!

• Diabetes risk increases with obesity and will
  more than double, from 140 million to 300 million
  in the next 25 years.
• Diabetes leads to serious complications such as
  heart, eye and kidney disease and a shortened
  life span.
• Costs of obesity to community gt 6b/y

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Syndromic Obesity

• Other terms that are used that generally refer to
  the same syndrome include
• Syndrome X
• Metabolic Syndrome
• Insulin Resistance Syndrome
• Deadly Quartet

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The Metabolic Syndrome

• Constellation of major risk factors, life-habit
  risk factors and emerging risk factors
• Over-represented among populations with heart
  disease
• Clue is distinctive body-type with increased
  abdominal circumference (although some leaner
  men and women can have metabolic syndrome)

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Diagnostic Criteria for Metabolic Syndrome
Diagnosis is made when 3 or more of these risk
criteria are met

• Glucose ? 6.1mmol/L
• Waist Circumference
• ? 102cm
• ?? 88cm
• HDL-C
• 1.0 mmol/L
• ? 1.3 mmol/L
• BP ?130/?85 mmHg
• Triglycerides ? 1.7mmol/L

? Glucose Abdominal Obesity ? HDL-C ?
BP ? TG
ATP III Guidelines
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Insulin Resistance Causes and Associated
Conditions
Aging
Inactivity
Obesity
Genetics
Genetics
INSULIN RESISTANCE
Type 2 diabetes
PCOS
NASH
Hypertension
Atherosclerosis
Dyslipidemia
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Insulin Resistance and Hypertriglyceridemia
625 500 400 300 200 100
r 0.73 P lt 0.0001
Plasma TG (mg/dL)
100
200
300
400
500
600
Insulin Response to Oral Glucose
Total area under 3-hour response curve (mean of
2 tests).
Olefsky JM et al. Am J Med. 197457551-560.
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Prevalence of Metabolic Syndrome
45
8814 aged 20 years or older from NHANES III
(1988-1994)
35
The age-adjusted prevalence men (24.0) women
(23.4).
0
Ford ES, et al JAMA 2002
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?????????
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Protein vs Carbohydrate in ad libitum Fat Reduced
Diet

• Skov et al 1999
• High-carbohydrate
• (HC, protein 12 energy) n25
• High-protein
• (HP, protein 25 energy) n25

• RESULTS AFTER 6 MONTHS
• 5.1 kg in the HC group
• 8.9 kg in the HP group (P lt 0.001)
• More subjects lost gt 10 kg in the HP group (35
  vs 9).
• HP diet decreased fasting plasma triglycerides
  significantly.

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Increased Protein/Carb Ratio

• Greater weight and fat loss - obese subjects
• (Skov et al,1999)
• Increased satiety - glucose tolerant women
• (Latner Schwartz, 1999)
• Thermic effects - obese, hyperinsulinaemic men
• (Hwalla Baba et al,1999)
• Lean body mass spared - glucose tolerant women
• (Piatti et al,1994)
• High protein/Low GI -25 decrease in ad libitum
  intake obese men
• (Dumesnil et al)

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Increased Protein/Carb Ratio CSIRO Studies

• Insulin sensitivity subjects with IGT
• (Clifton et al,1998)
• Greater abdominal fat mass loss Type 2 diabetes
  
• (Parker et al 2002)
• Greater lowering of LDL-C - Type 2 diabetes
• (Parker et al 2002)
• Thermic effect of HP meal 28 greater No change
  in REE - Type 2 diabetes
• (Luscombe et al 2002)
• Greater lowering of TG subjects with elevated
  insulin (Farnsworth et al (in press))
  
• Lean body mass spared subjects with elevated
  insulin (Farnsworth et al (in press))

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Renal Function

• Urinary albumin excretion was not affected by
  dietary protein during weight loss

• n19 with microalbuminuria
• HP diet 24.2 to 19.8 mg/l (n12)
• LP diet 4.3 to 3.5 mg/l (n7)

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Aim

• To compare a high protein weight loss diet with a
  high carbohydrate diet on
• weight loss and body composition
• nutrient status
• bone turnover markers
• measures of heart disease risk
• in women over 12 weeks ..and subsequently
  follow up for 1 year

• Diets
• 1. High carbohydrate
• 2. High protein, high red meat

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High Meat Protein 5600 KJ

• Cereal
• Low fat milk (250ml)
• Wholemeal bread (2 slices)
• Fruit (2)
• Beef/lamb 200g - dinner
• Chicken/fish/meat 100g - lunch
• Vegetables 2.5 cups
• Diet Yoghurt 200g
• Canola oil 3 tsp
• Wine 2 glasses/week (optional)

34 protein 20 fat 46 carbohydrate
109g protein 31g fat 161g carbohydrate
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High Carbohydrate 5600 KJ

• Cereal
• SKIM milk (250ml)
• Wholemeal bread (3 slices)
• Fruit (3)
• Chicken/pork/fish 80g
• Vegetables 2.5 cups
• Canola oil 3 tsp
• Pasta/rice 120g cooked
• Low fat biscuits 3
• Wine 2 glasses/week (optional)

17 protein 20 fat 64 carbohydrate
57g protein 31g fat 229 g carbohydrate
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Overall Results
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Weight Loss by Triglyceride Status
Sig diet effect
High protein
High carb
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DEXA
arm fat
abdominal fat
leg fat
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Total And Midriff Fat Loss Dexa Data
Sig diet effect
High protein
High carb
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LDL Cholesterol
High protein
?4.8
High carb
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Triglycerides
High protein
High carb
?4
?13
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Triglycerides by TG status
HIGH TG
?10
?28
LOW TG
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Triglyceride Change By Insulin Status
P0.036
?26
?9
High protein
High carb
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Calcium Excretion
Calcium excretion decreased on both diets
reference range 2.5-7.5mmol/24hr
Calcium excretion mmol/24hr
week 0 week12
High protein
High carb
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Protein vs Carb and Markers of Bone Turnover
Deoxypyridinoline/creatinine ratio
Pyridinolone /creatinine ratio
High carb
High protein
High protein
High carb
Both weight loss strategies associated with
increased bone turnover. No effect of diet
composition.
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Haemoglobin
Reference range 115-165g/L
No change

High protein High red meat
High carb
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Vitamin B12
Reference range 140-700 pmol/l
12 increase
13 decrease
High protein High red meat
High carb
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CONCLUSION 1
Moderately high protein high red meat diets and
conventional high carbohydrate weight loss diets
provide health benefits.

• Plasma triglycerides lowered on average 9

• LDL cholesterol lowered on average 5

• Insulin lowered on average 19
• Glucose lowered on average 4

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CONCLUSION 2
Moderately high protein high red meat diets
provide advantages in women

• Greater weight and fat and midriff loss on high
  protein diet in those women with elevated TG

• Greater lowering of plasma triglycerides on high
  protein
• diet in those women with elevated insulin or TG

• Haemoglobin levels improved more on high protein
  high red meat diet

• B12 status improved on high protei n high red
  meat diet

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CONCLUSION?
Moderately high protein diets can be a safe and
effective option to conventional high
carbohydrate weight loss diets.

• For some, HP diet may be easier to follow for
  longer
• periods as it may be more satisfying.

• HP diet as used in this study is safe and
  nutritionally adequate.

• It was easier to achieve RDI for all nutrients on
  HP diet

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Questions?
Health Sciences and Nutrition