What level is High Protein?

[lucylocket61]

I am getting the hang of carb levels but remain unsure about fat levels and protein.

Does anyone know what is a normal protein level, and what amount is considered a high protein diet please?

 

[phoenix]

Lucy,
as I had these for another post
RDAs protein
http://www.bupa.co.uk/members/mb-health ... d-you-know
Most of us normally eat much more than this.
A moderate protein diet for stage 3-4 kidney disease
http://renux.dmed.ed.ac.uk/EdREN/EdRENI ... ngKid.html

 

[xyzzy]

Lucy when I looked at this I came to the conclusion it is one of those diet only Type 2 things you have to make a judgement on.

Lets assume the RDA figure for protein is taken from a decent source such as this which is a joint position statement published by the ADA, DOC and ACSM. Key to that is the ADA (American Diabetes Association) the body that many countries diabetic position statements including the UK reference.

http://exercise.about.com/gi/o.htm?...u=http://www.ncbi.nlm.nih.gov/pubmed/19278045

So you don't have to read it then in essence it concludes, the more you exercise, the greater your protein needs will be. It gives how to work out an RDA for protein which is Weight in kg x FACTOR = RDA protein grams / day.

Where FACTOR is a number running between 0.8 and 1.8. Pick a lower number if you are in good health and are sedentary (i.e., 0.8 ). Use a higher number (between 1 and 1.8 ) if you are under stress, are pregnant, are recovering from an illness, or if you are involved in consistent and intense weight or endurance training.

So as an example I weigh 86.5Kg. I would guess my "correct" factor is around 0.9 so my RDA for protein is 77.85 grams per day.

Now here's the diet only T2 bit. You and I have a carbohydrate tolerance which as both our sigs say is set by our desire to stay at safe blood glucose levels. However that's the issue isn't it? If we have to fix our carb intake to keep us safe and then want to fix our protein at the RDA limit then the only other thing we can up is fat. It's that fact of life that makes diet only T2's different to our insulin using friends. They don't have to fix their carbs so much as they can inject insulin to cover a higher intake of carbs. Assuming they also stick to the protein RDA they can obviously have a lower fat intake if they want. So the debate insulin using diabetics have over low carb is subtly different.

Now of course as a T2 you can elect not to be diet only and say elect for more stronger meds or elect to use insulin and in that way you can either up your fixed limit of carbs a day or have the flexibility of using insulin may give you but we know both those ways have other risks associated with them.

So risk is the key phrase. When I elect to do my 60g / day carb regime I do so after weighing up those risks. I have to, that's part and parcel of being an informed T2 and taking control of my life. To those who like my specialist nurse and others who say eat 200 grams a day or do a 40% carb regime because of this risk or that risk I say "show me that the risks I would be taking by raising my blood glucose levels sky high is less than than risks of adopting a low carb diet".

Specifically tell me YOU would recommend that I as a diet only T2 with my 5.3% HbA1c, good cholesterol, excellent blood pressure and weight in the "normal" range adopt 200 grams a day or do a 40% carb regime in preference to the regime that my specialist diabetes gp has stated has "put my diabetes in remission". A case of put up or shut up.

The bottom line is as T2 I cannot eliminate all risks however much I would like to so my best option is to eliminate and reduce as many of those risks as possible. To me a low carb regime that is obviously working is vastly superior even if it may have other possible risks elsewhere and is easily my preferred option. Better still my specialist diabetes gp agrees and supports me doing it.

 

[noblehead]

xyzzy,

I don't know if you missed it earlier but Lucy has problems with her kidneys.


''I have kidney problems since before i was diagnosed as T2.''

 

[phoenix]

Unfortunately our kidneys don't discriminate between whether we take insulin or not.
If you don't have CKD, fine. Relatively high protein may not be a problem.
I would urge everybody makes sure that they have creatinine tests and checks for protein in their urine and that they ask their doctor whether their estimated function is within normal ranges and whether it has declined since the last test.
There are lots of people with D who do have diminished kidney function. This is one of the reasons that authorities giving general dietary advice tell people with problems to see a dietitian and that the advice they give has to take these possible problems into account.
I don't actually know what Lucy's problem is, which is why I gave a specific link mentioning the stages of CKD so that she can decide and/or ask her doctor whether it is relevant to her.

 

[xyzzy]

xyzzy,

I don't know if you missed it earlier but Lucy has problems with her kidneys.


''I have kidney problems since before i was diagnosed as T2.''

No I didn't miss that and as Lucy will attest I PM'ed her separately about the kind of things she could talk to her GP about regarding mitigating the risks as part of my recent discussions with my own specialist diabetes gp were along a similar theme. My post simply points out how using latest research you can calculate the RDA for protein and the implications of staying at the RDA for protein while also effectively fixing carbohydrate intake as well. The implication is obvious which is to get a reasonable calorific intake you are likely to have to up the fat in your regime. Pretty obvious as that's why most low carb regimes are namely low carb high fat regimes or LCHF as shorthand. No one is recommending a low carb high protein regime especially if they have an impaired kidney function. I have both roughly fixed my carbohydrate intake and my protein intake but upped my fat significantly and have seen huge IMPROVEMENTS in my cholesterol levels so a LCHF approach appears to both be safe and beneficial.

Unfortunately our kidneys don't discriminate between whether we take insulin or not.

I'm glad we agree Phoenix as that is what I said too. The difference as I pointed out is that as diet only T2's we need, with the help of our GP's and other expert T2 opinion to make a risk assessment to end up at a regime which we feel has the safest carbohydrate / protein / fat balance or put it another way minimise our risks.

If we are forced by wanting safe blood levels to fix our carbohydrates to so many grams per day and likewise told it's best to fix our protein at round about the RDA then by implication most of us, unless you are Sid or Grazer, end up adopting LCHF by default as otherwise we would starve. Even 200g or 40% (which is what I understand you recommend but do correct me if I'm wrong) is still slightly under the UK RDA for carbs. The question I would ask you Phoenix or anyone else is would you, based on seeing the improvements I have made in terms of HbA1c, cholesterol, blood pressure and weight loss and given I have discussed in detail with my diabetes specialist gp and taken his advice on this protein RDA issue insist I should up my carbs back to 40%? A very simple yes or no answer.

 

[Grazer]

insist I should up my carbs back to 40%? A very simple yes or no answer

NO is the simple answer. I fear, however, that you won't just get simple answers.
I don't know Lucy's kidney info, but if you've PM'd her as you say regarding talking to her GP, and as a result she makes herself aware of any risks, then as a big girl (Not literally Lucy!) it's down to her.
Personally, I wonder if we think too much about this whole Carb/fat/protein mix.
My start point was to reduce my carbs until I hit my desired BG levels. That was of paramount importance to me as diet only T2. If I had other illnesases, I'd have considered them in my targeting. But BGs had to be achieved. Fortunately, for me, that arrived at a moderate carb level.
I didn't then say "what must I now do with proteins, fats etc"
I simply carried on eating the same protein as I had before with a bit more (ended up a lot more!) fat as treats to replace the carby treats (clotted cream, extra cheese etc). I then waited to see what happened.
What happened was my BMI went down to 22 then stayed there.
My Blood pressure (measured by doc) went from 155/85 to 118/66 (measured 2 days ago)
My cholesterol went from 5.5 to 3.8
Typical resting pulse rate went from 74 to 66
My HbA1c went from 8.2 to 5.9 (awaiting result from test 2 days ago, hoping for 5.6)

So, whatever I did by accident, (regarding fat and protein), seemed to be about right to me.
I suppose the point I'm making is that I didn't concern myself about ANYTHING other than getting BG right with adjusted carbs, because I KNEW how bad high BGs were, and I just let everything else sort itself out. I would repeat though that if I had anything else seriously wrong with me I'd have checked that out before changing my diet, which I think Lucy is doing.
Out of interest, I DID invest £200 in a 30 min private consultation with an Endo who specialises in Diabetes and, In fact, Lectures doctors on diabetes, Is head of diabetes at a specialist hospital etc; in other words, knows his stuff. I wanted to know if a life-long reduction in carbs was OK, if my views on alcohol were ok, his views on alcohol and metformin, hypos, neuropathies and so on. I went armed with a long list of questions. He was very supportive of my approach and positive in his answers which is why I don't feel bad about passing it on to others.

 

[lucylocket61]

Thank you all for your replies

I will inform myself via the links and info in this thread, and the pm from xyzzy. Then see my GP to discuss her opinions, view and advice. Then weigh it up in my mind before making any big changes.

At them moment i will stay with a moderate protein intake until I know/understand more.

I hadnt even thought about protein intake and kidney until yesterday so I am very grateful that the subject was raised in another thread and I was alerted to possible problems before i did anything to change my protein intake. There is so much to learn about this disease, isnt there.

 

[lucylocket61]

PS I forgot to add that , until I read about protein and kidneys on here I had NO idea there could be a problem for my situation, as at the surgery not one person has mentioned it!!!

It may well be that they didnt mention it because it isnt a problem, or because they are saying Low-fat, low protein (around 25% of each), 50% carbs diet so my protein intake would, according to their calculations, be low anyway.........but its best to be sure i think.

 

[Dillinger]

Here is a study on protein and renal function.

http://www.nutritionandmetabolism.com/content/2/1/25

Note that it says 'While protein restriction may be appropriate for treatment of existing kidney disease, we find no significant evidence for a detrimental effect of high protein intakes on kidney function in healthy persons after centuries of a high protein Western diet.'

I know Lucy has existing kidney problems - if they are related to her diabetes then surely it is her glucose levels that are causing the problems not the protein. Protein restriction may be appropriate (note 'may be') in response to that but isn't that just saying the kidney function is impaired a bit so don't over stress it?

Protein consumption itself won't cause kidney problems.

Those who don't have existing kidney problems shouldn't worry about the amount of protein that they eat; as has been said many times its the carbs that matter, because reducing them is the easiest way to control blood sugars.

Best

Dillinger

 

[noblehead]

No I didn't miss that and as Lucy will attest I PM'ed her separately about the kind of things she could talk to her GP

Ah that's good to know I didn't know if you had seen the other thread yesterday. I don't really use the pm system to offer advice as I like anything I say to be open and transparent.......good or bad! :lol:

 

[noblehead]

Thank you all for your replies

I will inform myself via the links and info in this thread, and the pm from xyzzy. Then see my GP to discuss her opinions, view and advice. Then weigh it up in my mind before making any big changes.

At them moment i will stay with a moderate protein intake until I know/understand more.

I hadnt even thought about protein intake and kidney until yesterday so I am very grateful that the subject was raised in another thread and I was alerted to possible problems before i did anything to change my protein intake. There is so much to learn about this disease, isnt there.

That's very sensible Lucy to discuss this first with your GP, good luck and hope all goes well!

 

[xyzzy]

No I didn't miss that and as Lucy will attest I PM'ed her separately about the kind of things she could talk to her GP

Ah that's good to know I didn't know if you had seen the other thread yesterday. I don't really use the pm system to offer advice as I like anything I say to be open and transparent.......good or bad! :lol:

No I didn't offer her hidden advice just that it maybe worth her while talking to her GP because she would hopefully get an experts view. I gave her examples of what by GP had explained to me as options regarding protecting kidney function if I ever needed to. I do not feel obliged to discuss all aspects of my personal care on a public forum but was happy to share the information confidentially with Lucy as I thought it would be helpful. Apparently it was.

As I understand it Nigel you do around a 120g / day carbs or roughly a 25% carbohydrate regime? If that's the case then unless you are eating well over the protein RDA you must be on what would technically be a LCHF yourself? Maybe I've got that wrong if so I apologise in advance.

 

[lucylocket61]

Thank you for your concern Noblehead. People are so kind and thoughtful here. I am constantly surprised by this and it makes a refreshing change form my surgery.

I don't really use the pm system to offer advice as I like anything I say to be open and transparent.......good or bad! :lol:

I can appreciate that, and it is something I mostly try to do. Sometimes, however, there is more personal or medical detail than I like to mention in public. Also, because of my job, I am keen to avoid anything mentioned which would maybe reveal my identity too much. I am sure you understand. So the pm system is helpful in that way.

If I receive anything by pm which bothers me, I will let the admin know at once.

Its so good that everyone wants to keep people safe here.

 

[noblehead]

Thank you for your concern Noblehead. People are so kind and thoughtful here. I am constantly surprised by this and it makes a refreshing change form my surgery.

No problem Lucy I just like be sure that people are receiving the best advice possible, as you had already said you had some kidney damage I/we were concerned for your welfare.......hence why we said to speak with your HCP's first, and yes I do understand that you want your privacy and don't wish to disclose certain things about yourself.

Best wishes!

 

[borofergie]

Let's stick with the facts:

1. RDA UK for protein = 55g
2. RDA US for protein = .36g per lb body weight = 90g in my case
3. Moderate Protein diet for kidney disease from Phoenix above=0.8 to 1g per kg body weight = 90 to 113g in my case
4. New Atkins for a New You=90 to 193g for someone of my height
5. Jeff Volek = maximum of 18% energy from protein= 112g in my case

So can someone please tell me how low-carb diets are apparently high-protein? The numbers a above are largely consistent with Phoenix's diseased kidney diet, and much less than the typical non-vegetarian eats in a day.

It's quite simple, you need enough protein to meet your structural needs plus a little bit of gluconeogenesis. if you eat more protein than that you'll kick yourself out of ketosis and mitigate the effects of low-carbing in the first place.

The point of low-carbing is that you allow the satiating effect of protein to govern your calorie intake (rather than being confused with BG swings). The evidence suggests that under these conditions your appettite is governed almost entirely by your need to meet your protein requirement and no more. If you eat a high-carb low protein diet you'll end up eating lots more calories in trying to meet your protein requirement.

 

[phoenix]

I have made in terms of HbA1c, cholesterol, blood pressure and weight loss and given I have discussed in detail with my diabetes specialist gp and taken his advice on this protein RDA issue insist I should up my carbs back to 40%? A very simple yes or no answer

and you won't get it except in so far as I have said that there seems to be to no evidence to suggest higher protein intakes in themselves cause loss of kidney function. You have discussed it with your own doctor, he/she is the person to advise you.

In contrast I will point out how the evidence relates to my own experience.
The Nurses health study found a significantly measurable association between decline in kidney function and the consumption of about 1.3 grams of animal protein for each kilo in those that already had diminished function. There was no such association in those that had normally functioning kidneys at the start of the study.
Diminished function in the study was defined as an estimated GFR ≥ 80 mL/min per 1.73 m2.
Paper
http://www.annals.org/content/138/6/460.short
web mds account (caution it does mention Atkins as this was mentioned by the researcher interviewed)
http://www.webmd.com/diet/news/20030317 ... rt-kidneys



My own egfr was 62m/min at diagnosis though there was no microalbuminuria in my urine. This level was under the 80ml/min and was only 2 ml /min above CKD stage 3. I was quite concerned at the time since renal function can decline in any event with age and spent some time talking to my doctor about it.
I ate and continued to eat a fairly normal but not high amount of protein (probably like most people a bit above the RDA, I don't count it religiously). I am fortunate that my kidney function has improved over the last seven years and is now above that 80mil/min mark, I'm not going to attribute that to diet, as it obviously is to do with a mixture of things including good glucose control and exercise (which of course requires a certain level of protein for muscle repair) Personally, I wouldn't have felt a high protein diet was a good idea for me, even if the diagnosis had been as I expected T2.

Stephen: one point

Moderate Protein diet for kidney disease from Phoenix above=0.8 to 1g per kg body weight = 90 to 113g in my cas

The amount per kilo in this case is amount per kilo of ideal body weight.

 

[borofergie]

No I didn't miss that and as Lucy will attest I PM'ed her separately about the kind of things she could talk to her GP

As I understand it Nigel you do around a 120g / day carbs or roughly a 25% carbohydrate regime? If that's the case then unless you are eating well over the protein RDA you must be on what would technically be a LCHF yourself? Maybe I've got that wrong if so I apologise in advance.

I'm interested in this too...

In the interest of disclosure my diet (averaged over the last week from cron-o-meter):
18% protein = 110g a day
3% carbohydrate = 18g a day
79% fat = 200g a day.

Would you mind telling us what your typical macronutrient ratio is Nigel?

 

[borofergie]

Stephen: one point

Moderate Protein diet for kidney disease from Phoenix above=0.8 to 1g per kg body weight = 90 to 113g in my cas

The amount per kilo in this case is amount per kilo of ideal body weight.

Good point, but that would still only be 50 to 90g a day and still isn't very far out of line with the numbers above (assuming ideal means lean body mass, which it probably doesn't, so you could add a few more grams onto even that number).

I eat 110g and I run 20 miles a week and eat far less carbs than Atkins or anyone else recommends. The amount of extra protein required to generate the 25g of glucose your brain requires is only about 10g. That isn't going to break anyone's kidneys.

 

[phoenix]

So can someone please tell me how low-carb diets are apparently high-protein?

Well it must depend on what you actually do and how many calories you end up eating. The Atkins diabetes book quotes a much higher percentage of protein than is in your diet.
Atkins Diabetes Revolution, p168

The amount of protein when you follow the ARSCP may not be that much higher than the amount you ate before you started the programme. When the dietary intake of individuals following the ANA has been studied, generaly 30-35% of their calorie intake is protein.'

ANA=Atkins nutritional Approach; I haven't worked out ARSCP