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High Protein Low Carbohydrate Diets: Targeting Who Benefits

High Protein Low Carbohydrate Diets: Targeting Who Benefits. Dr Manny Noakes Senior Research Dietitian CSIRO Human Nutrition (Clinical Research Unit). Obesity Epidemic. Diabetes risk increases with obesity and will more than double, from 140 million to 300 million in the next 25 years .

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High Protein Low Carbohydrate Diets: Targeting Who Benefits

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  1. High Protein Low Carbohydrate Diets: Targeting Who Benefits Dr Manny Noakes Senior Research Dietitian CSIRO Human Nutrition (Clinical Research Unit)

  2. 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 > $6b/y

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

  4. 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)

  5. 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

  6. Insulin Resistance: Causes and Associated Conditions Aging Inactivity Obesity Genetics Genetics INSULIN RESISTANCE Type 2 diabetes PCOS NASH Hypertension Atherosclerosis Dyslipidemia

  7. Insulin Resistance and Hypertriglyceridemia 625 500 400 300 200 100 r = 0.73 P < 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. AmJMed. 1974;57:551-560.

  8. Prevalence of Metabolic Syndrome 8814 aged 20 years or older from NHANES III (1988-1994) 45 35 0 The age-adjusted prevalence : men (24.0%) women (23.4%) Ford ES, et al JAMA 2002

  9. Marketing Weight Loss

  10. Protein Versus Carbohydrate in ad libitum Fat Reduced Diet Skov et al 1999 • High-carbohydrate (HC, protein 12% energy) n=25 • High-protein (HP, protein 25% energy)n=25 Results After 6 Months • 5.1 kg in the HC group • 8.9 kg in the HP group (P < 0.001) • More subjects lost > 10 kg in the HP group (35% vs 9%). • HP diet decreased fasting plasma triglycerides significantly.

  11. Increased Protein / Carbohydrate Ratio Greater weight and fat loss (Skov et al,1999) • Obese subjects Increased satiety(Latner & Schwartz, 1999) • Glucose tolerant women Thermic effects (Hwalla Baba et al,1999) • Obese, hyperinsulinaemic men Lean body mass spared (Piatti et al,1994) • Glucose tolerant women High protein/Low GI (Dumesnil et al) • 25% decrease in ad libitum intake • Obese men

  12. Increase Protein / Carbohydrate Ration: CSIRO Studies • Insulin sensitivity (Clifton et al,1998) • Subjects with IGT Greater abdominal fat mass loss (Parker et al 2002) • Type 2 diabetes Greater lowering of LDL-C (Parker et al 2002) • Type 2 diabetes Thermic effect of HP meal 28% greater (Luscombe et al 2002) • No change in REE • Type 2 diabetes Greater lowering of TG (Farnsworth et al (in press)) • Subjects with elevated insulin Lean body mass spared (Farnsworth et al (in press)) • Subjects with elevated insulin

  13. Renal Function • Urinary albumin excretion was not affected by dietary protein during weight loss: • N=19 with microalbuminuria. • HP diet: 24.2 to 19.8 mg/l (n=12) • LP diet: 4.3 to 3.5 mg/l (n=7)

  14. Aim • To compare a high protein weight loss diet with a high carbohydrate diet in women participating in a 12 week intervention (and subsequent follow up for 1 year) on the following outcomes: • Weight loss and body composition • Nutrient status • Bone turnover markers • Measures of heart disease risk • . • Diets: • High carbohydrate • High protein, high red meat

  15. 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

  16. 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 229g carbohydrate

  17. Overall Results

  18. Weight Loss by Triglyceride Status * Sig Diet Effect High Protein High Carb

  19. DEXA Arm Fat Abdominal Fat Leg Fat

  20. Total And Midriff Fat Loss - DEXA Data * Sig Diet Effect High Protein High Carb

  21. LDL Cholesterol 4.8% High Protein High Carb

  22. Triglycerides High Protein 4% High Carb 13%

  23. Triglycerides by TG status HIGH TG 10% 28% LOW TG High Protein High Carb

  24. Triglyceride Change By Insulin Status P=0.036 26% Insulin Split Change in TG Low Insulin High Insulin 9% High Carb High Protein

  25. Calcium Excretion Week 0 Week 12 Calcium excretion mmol/24hr Reference Range: 2.5-7.5mmol/24hr High Protein High Carb Calcium excretion decreased on both diets

  26. Protein versus Carbohydrate and Markers of Bone Turnover Deoxypyridinoline/creatinine ratio Pyridinolone /creatinine ratio Week 0 Week 12 High Protein High Carb High Protein High Carb Both weight loss strategies associated with increased bone turnover. No effect of diet composition.

  27. Haemoglobin No change Reference Range: 115-165g/L * Mean Week 0 Week 12 High Protein High Carb

  28. Vitamin B12 Reference Range: 140-700pmol/L 12% increase Week 0 Week 12 13% decrease High Protein High Carb

  29. 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%.

  30. Conclusion #2 • Moderately high protein high red meat diets provide advantages in women. • Greater weight, 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 protein high red meat diet.

  31. Conclusion #3 • 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.

  32. Questions? Booklet released in August 2003 in the Australian Women’s weekly, then as a free booklet by Meat & Livestock Australia (MLA). Book 1 published in May 2005.

  33. Thank You Contact CSIRO Phone 1300 363 400 +61 3 9545 2176 Email enquiries@csiro.au Web www.csiro.au CSIRO Human Nutrition Name Associate Professor Dr Manny Noakes Title Senior Dietitian / Research Scientist Phone +61 8 8303 8827 Email manny.noakes@csiro.au Web www.csiro.au/twd

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