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NutritionforHealthy WeightLoss By Iris Zieler (Medical StudentatUniversity College London) Kindly hosted byUCL LifestyleMedicine Society Special thanks to Dr. Oliver Witard & Dr.CourtneyKippsfortheir expertise and guidance ©️ Iris Zieler Outline 1.0 Reasonsto desireweightloss 2.0 Whatis healthy weightloss? 3.0 Roleofproteinduringweightlossinobese population 4.0 Roleofproteinduringweightlossinathletes 5.0 Dangersassociatedwithhighprotein 5.1 Criticalanalysis 5.0 Guidelinesforuseof proteininweightloss ©️ Iris Zieler Whyloseweight? • Obesity ©️ Iris Zieler Whyloseweight? • Obesity • Exercisers ©️ Iris Zieler Whyloseweight? • Obesity • Exercisers • Athletes • Weight category athletes ©️ Iris Zieler Whyloseweight? • Obesity • Exercisers • Athletes • Weight category athletes • Increase power-to-massratio ©️ Iris Zieler Whyloseweight? • Obesity • Exercisers • Athletes • Weight category athletes • Increase power-to-massratio • Aestheticsports ©️ Iris Zieler Whatishealthyweightloss? ©️ Iris Zieler Healthyweightlossis… The loss of fat mass (particularly visceral fat)andthe preservation of muscle mass ©️ Iris Zieler Compositionofbody masslostduring hypocaloricdieting ↓body m→ss↓muscle mass Energydeficit impairs muscle proteinsynthesis al. JCEM2008 ©️ Iris Zieler Doesdietcompositioninfluence theoutcomeofhypocaloric dietingintheobesepopulation? ©️ Iris Zieler Roleofdietcomposition • Obese women(BMI>30, 45-56y) • 10wk hypocaloric diet (1700kcal/day) ) • Proteinvs CHO group k • Proteingroup= CHO/Pro:1.5 s • CHO group=CHO/Pro:3.5 l M F s l Ahigh protein hypocaloricdiet t resultsin greateroverall loss of F bodymass and fat mass relative to musclemass Weeks Carbohydrate Laymanetal Protein JNUTR 2003 ©️ Iris Zieler Adding exercisetraining furtherincreasesfatloss CHO/Pro = 3.5 CHO/Pro = 3.5 CHO/Pro = 1.5 CHO/Pro = 1.5 Laymanetal JNUTR 2005 ©️ Iris Zieler Highdairyprotein intakeincreasesfatloss + musclegainduringweightloss(obesefemales) adequate protein, lowdairy adequate protein, mediumdairy highprotein,highdairy Josse etal. Jnutr 2011 ©️ Iris Zieler Whey proteinsupplementationpreserves postprandial rates of muscle proteinsynthesis during short-term energy restrictioninoverweight adults 0.10 Pre Post 0.08 9% Reduction in rates of postprandial MPS a c 0.06 e n S 0.04 28% a t r 31% F 0.02 0.00 Whey Soy CHO Hector et al J Nutrition 2015 ©️ Iris Zieler InterimSummary In obese & overweight individuals, increased protein intake during hypocaloric weight loss seems to... • Increase total body mass loss • Increase fat mass loss • Maintain muscle mass • High protein weight loss dietwith high dairycomponentmaybe most effective for achieving weight loss with high ratio of fat:muscle mass loss ©️ Iris Zieler Potentialmechanisms • Thermogenesis • TEF for protein= 20-35% vs CHO = 5-15% • Satiety • ~30% greaterwithhighprotein • Increased protein synthesis • Proteinstimulatesmuscle proteinsynthesis • More muscle =higherBMR • Increased fatoxidation ©️ Iris Zieler Whataboutathletes& exercisers? ©️ Iris Zieler Differences between obesevs.athletes/exercisers • Amount of weightto be lost • Performance vs.health parameters • Fatvs. carbohydrate to balance protein content ©️ Iris Zieler Highproteinintakelimitslossof leanbody massinweightlifters 0 Control Highprotein 60%total energy requirement -500 for2 weeks • HP =35% protein ( • Control=15% protein s -1000 o t h e -1500 W -2000 -2500 Fat FFM MSSE2010et al. -3000 ©️ Iris Zieler Faster weightloss means greaterlossof lean mass SR FR 2 weight fat ) 0 k LBM e g -2 a h C -4 -6 IJSNEM 2011. ©️ Iris Zieler InterimSummary In athletes: • Increased protein intake during hypocaloric dieting reduces %FFM lost • Slower weight loss preserves FFM ©️ Iris Zieler Negativeeffectsofhighprotein • Increased subjective scores of fatigue • Increased mood disturbances,i.e.‘worse than normal’scores on DALDA Therefore: • If totalmass lost is the main goal,perhaps high protein not appropriate ©️ Iris Zieler Potentialdangersassociatedwith highproteinintake ©️ Iris Zieler Potentialproblemswithhighproteindiets Kidney problems ➢Noknown cases inotherwisehealthy individuals ➢May be important considerationforthose withunderlying kidney damage Bone Loss ➢Evidence from animal &cellstudies suggesting increasedboneloss ➢Meta-analysis (Darling eta: no associationbetweenprotein intake&bone problems inhumans ➢ Slightpositive association of proteinintake and bone health Compromiseintake of other nutrients (e.g. CHO) ©️ Iris Zieler Do high proteindietscause kidneydisease? • CHRIS study sub-analysis (cross-sectional) • General populationSouthTyrol ”Higherintake ofproteins from animal sources suchas fish, poultry, redmeat, andprocessedmeat wasassociated with higherserum creatinine(SCr) and lowereGFR levels” Nephrol2023. J ©️ Iris Zieler Do high proteindietscause kidneydisease? • Rodeet al.(2021):polar bears • Zoo bears fed high-protein diet: 37% died from kidneydisease • Bears dying from kidney disease were~10years youngerthan those dying of other causes • Serum urea& creatininein zoo bears with CKD significantly higherthan wild bears BUT… • Narasaki et al.(2021):retrospectivecohort study (USA) • In CKD: high DPI& greater high biological valueprotein consumption associated with higher mortality • In healthy: low DPI associated with higher mortality ©️ Iris Zieler Reasons for discrepancy 1 CHRIS Study:estimated GFRbasedonfasting serum creatinine(SCr) UnderestimationofGFRinindividualswithlarge muscle mass Animalproteinmay transiently increaseexogenouscreatinine ➢ Increased SCr, sodecreased eGFR 2 Rode etal.used animalswhohavedifferentdietary requirementstohumans Findings may not directlytranslatetohumans 3 CHRIS Study & Narasakietal. estimated poteinintake fromFFQ/24hrecall Recallbias 4 SCr,eGFR,serum ureaarebiomarkers:not definitive measureof kidneyfunction ©️ Iris Zieler Guidelines foruseofproteinforweight lossinclinicalsettings • Aimfor gradualweight loss via moderate decrease in energy intake + increase in energyexpenditure (viaexercise programand/or habitualactivity) • For gradualweight loss & preservation of muscle mass: • Overweight individuals:consume CHO:protein ratioof ~3:2 + increase activity (preferably withresistanceexercise asamajorcomponent) • Overweight &obesesedentary individuals:proteinmay beincreased in dietat expense ofCHO ©️ Iris Zieler Guidelines foruseofproteinforweight lossinathleticpopulation • Recommendations shouldbe individualized based on their training/competition goals • If absolute amount of weight lost is primarygoal, high protein diet maynot be best choice • If more important to maintain muscle while losing moderate amountsof weight, high protein diet at expense of fat(NOT carbohydrate)is recommended • Rate of weightloss may be important ©️ Iris Zieler Importance ofStrengthTraining Crucialfor healthyweight loss Lifting weights helps: • Build &preserve muscle mass during weight-lossperiod • Enhance rate of body fat loss ©️ Iris Zieler Questions? ©️ Iris Zieler