Is Protein in Keto important?
Protein is an essential macronutrient and comes from the greek word Proteos meaning The Most Important one. Protein is everything your body is made from, from your hair, bones, organs, skin; even peptide hormones are made out of protein.
Many people believe that a ketogenic diet is a high-protein diet. This is a myth, a ketogenic diet balances a moderate level of protein with lowered carbohydrates and is high in healthy fats.
Many people also believe that excess protein just turns into sugar in the body. This is also a myth, as it is very dependent on context. We see people throwing around the word HIGH protein around stocking fear in others, without even defining what HIGH protein is:
This leads to many questions:
What is the ideal protein intake? How much is too low protein? Does the amount of protein I eat in one meal matter? Why is too much protein dangerous?
In order to answer these frequently asked questions it is important to be aware of the variation in dietary protein intake, even the differing views discussed amongst the expects in the known community.
I belive in order to establish optimal values in protein intake we need to take into account many seemly differing expert opinions, to build a complete clearer picture on what optimal protein levels are.
I want to bring to the table 9 experts known within the health community, to weigh in on the discussion of protein:
Dr Jason Fung / Dr Stephen Phinney / Dr Ron Rosedale / Dr Donald Layman / Dr. Layne Norton
Dr. Robert Heaney / Menno Henselmans / Dr Réjeanne Gougeon / Dr Richard Bernstein
Dr Jason Fung on Nitrogen Balance
Dr. Jason Fung is a nephrologist (kidney specialist) and Program Medical Director at Intensive Dietary Management and practices at Scarborough General Hospital at Ontario, Canada.
During October 2016 Jason teamed up with Jimmy Moore to write The Complete Guide to Fasting which captures Jason’s extensive thoughts on fasting from the blog along with Jimmy’s n=1 experiences.
Controversy arose in the LCHF and Keto community in regards to the lower/higher levels of protein, so Dr Fung wrote an extensive blog post on his intensive dietary management website called, How much protein is excessive?
Dr Fung’s protein recommendations are built around the the minimal RDI levels of Nitrogen balance without loss of lean mass, and states the following:
“In 1985, the WHO reviewed studies of daily obligatory losses of nitrogen, and found that an average is 0.61 g/kg/day (total). Presumable, the diet should replace (roughly) this 0.61 g/kg/day being lost. Remember, this average is for normal healthy people, not people losing muscle or otherwise sick. So the international group recommended that normal healthy people should get roughly 0.6g/kg/day. In order to make sure everybody was covered, the WHO added 25% (2 standard deviations) above the mean to get 0.75 g/kg/day which sometimes gets rounded up to 0.8 g/kg/day. In other words, 97.5% of the healthy general population loses less than this 0.75 g/kg/day of amino acids. This is not a low standard. This is a very, very high standard of protein intake.” – Dr Fung
Why do we look at Nitrogen as important? The main reason why medical professionals talk about it, is it’s an excellent laboratory tracker to measure protein loss from the body. This is because compared to the other macronutrients (protein, carbohydrates and fats) which contain a carbon, hydrogen and oxygen molecule, protein is the only macronutrient that also contains an additional nitrogen molecule. By getting people to study and carefully counting all the nitrogen content of foods and comparing it to the amount of nitrogen balance they find three different results:
Positive Nitrogen Balance: Nitrogen intake is greater than nitrogen output. Essentially, this is the body’s anabolic (build) state.
Negative Nitrogen Balance: If your nitrogen loss is greater than your nitrogen intake. Not only is nitrogen drawn away from muscle, where it is needed for growth, it is also taken from the vital organs where serious damage can occur. Of course, negative nitrogen balance also destroys muscle and is consequently considered a catabolic state.
Equilibrium: This is the the state you want at a very minimum – where nitrogen intake and loss are equal. In this state you won’t be able to build muscle but you also will not be in a catabolic state.
Then taking the protein levels from Dr Fung’s blog, we get his following protein recommendations, and catchphrases, from his clinical experience:
Dr Stephen Phinney on optimum therapeutic window
Dr. Stephen D. Phinney is a Professor of Medicine Emeritus at UC-Davis. He is on the editorial board of the American Journal of Clinical Nutrition.
He has twenty-five years of clinical experience as a director of multidisciplinary weight management programs and has contributed to books and peer reviewed articles and is an expert in low carb nutrition and metabolism, fatty acids, inflammation, and the metabolic syndrome.
He is now devoting his time to Virta Health, formed by scientists on a mission to cure the most complex chronic diseases, operating in downtown San Francisco.
According to Dr Steve Phinney’s chart below, a “Well formulated ketogenic diet” (WFKD) contains between 3 and 20% carbohydrates and between 10 and 30% protein.
In regards to defining optimal protein levels in a ketogenic diet, Dr Phinney says in the Nutrition & Metabolism:
“The third dietary factor potentially affecting physical performance is adjusting protein intake to bring it within the optimum therapeutic window for human metabolism. The studies noted herein [13, 14, 15, 20] demonstrate effective preservation of lean body mass and physical performance when protein is in the range of 1.2 – 1.7 g/kg reference body weight daily, provided in the context of adequate minerals. Picking the mid-range value of 1.5 g/kg-d, for adults with reference weights ranging from 60–80 kg, this translates into total daily protein intakes 90 to 120 g/d. This number is also consistent with the protein intake reported in the Bellevue study [9]. When expressed in the context of total daily energy expenditures of 2000–3000 kcal/d, about 15% of one’s daily energy expenditure (or intake if the diet is eucaloric) needs to be provided as protein.”
For performance it was found that if the protein was too low then “The effects of reducing daily protein intake to below 1.2 g/kg reference weight during a ketogenic diet include progressive loss of functional lean tissue and thus loss of physical performance, as demonstrated by Davis et al [21]. In this study, subjects given protein at 1.1 g/kg-d experienced a significant reduction in VO2max over a 3 month period on a ketogenic diet, whereas subjects given 1.5 g/kg-d maintained VO2max.”
Yet if protein was increased too high issues are also seen “At the other end of the spectrum, higher protein intakes have the potential for negative side-effects if intake of this nutrient exceeds 25% of daily energy expenditure. One concern with higher levels of protein intake is the suppression of ketogenesis relative to an equicaloric amount of fat (assuming that ketones are a beneficial adaptation to whole body fuel homeostasis). In addition, Stefansson describes a malady known by the Inuit as rabbit malaise [8]. This problem would occur in the early spring when very lean rabbits were the only available game, when people might be tempted to eat too much protein in the absence of an alternative source of dietary fat. The symptoms were reported to occur within a week, and included headache and lassitude. Such symptoms are not uncommon among people who casually undertake a “low carbohydrate, high protein” diet.”
To close on protein intake on a ketogenic diet, Dr Phinney says “Too little or too much protein can be problematic in the keto-adapted state. Rather than consume large portions of meats or other protein foods, focus on small to moderate protein portions and combine them with generous portions of good sources of fat (e.g., sauces, butter, olive oil)”
Dr Ron Rosedale on mTor and Anti-aging
Ron Rosedale M.D. is a medical professional, specializing in nutritional and metabolic medicine whose key areas of work are diabetes and diet. He is also the author of book the Rosedale Diet. He is an alumnus of Northwestern University School of Medicine, 1977. He is based in Denver, Colorado
Many in the health community regard Dr Rosedale as an anti-aging expert and was one of the first to draw attention the importance of insulin in 1995. He is now focusing on the protein effect on mTOR in connection with insulin and aging.
Dr Rosedale protein recommendations are clinically focused on mTOR/insulin on diabetes and aging.
He highlights “One of the primary problems with excess protein or amino acids is that it stimulates mTOR, which stimulates growth rather than regeneration. Fat calories did not stimulate mTOR, leptin or insulin. They were essentially metabolically free calories.”
Rosedale found a diet high in healthy fats that worked quite well for diabetes and heart disease patients. Over time, he discovered that restricting protein was another important factor that could affect health, and even more specifically, the aging process.
So bundling his clinical experience while also considering the prospect of longevity Dr Rosedale says “For people, I’ll put on .7 or .75 grams per kilogram of lean body mass. But if I’ve got a diabetic, and I really want to reverse their aging, which means reverse their diabetes, because diabetesis a model of aging, I’ll put them down to 0.5 or 0.6 grams per kilogram of lean body mass per day.”
In 2016, Rosedale feels that cutting down to 0.75 grams per kilo of lean body mass may actually be a more ideal amount for everyone, and also says you could even go below that because your body will conserve protein when you suppress mTOR and increase maintenance and repair. [YoutTube]
In the past Dr Dr Rosedale said that “on average, you want to have approximately one gram of protein for every kilogram of lean body mass (that is, the weight of your body minus the fat – we all have some fat). The easiest way to calculate your daily protein requirement is to take your ideal weight in kilograms (that is, what you would like to weigh if you could weigh anything) and have roughly one gram of protein per kilogram, minus 10%.“
Then taking the protein levels from Dr Rosedale we get his follow protein recommendations, the higher ends are from his previous recommendations:
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