Issue 125 diet trends high protein diets for weight loss with ads

WEIGHT MANAGEMENT

DIET TRENDS: HIGH PROTEIN DIETS FOR WEIGHT LOSS Claire Chaudhry Community NHS Dietitian/ Private Dietitian BCUHB/ Claire Sports Nutrition

‘Trend’: meaning; to roll around, turn, revolve.1 Popular trends, like diets and styles of denim jeans, often complete a full circle many times throughout our adult lives. Now we are seeing a comeback for the high protein diet for weight loss. Here, Claire examines the advantages and disadvantages of this kind of diet.

In Claire’s 15 years of experience she has worked in acute and community NHS settings. Claire has taught Nutrition topics at universities and colleges and regularly provides talks to groups, NHS and private. www. dietitianclaire.com

In 2004, I had my second interview with a journalist for a local paper, with a sensational headline: ‘Fad diets like Atkins could be harmful’. The headline was decided by the journalist Justine Bailey and not quoted by me. In the article, I emphasised the importance of a balanced diet for weight loss, steering clear of diets that omit food groups and offer quick fixes. I also emphasised consulting a dietitian for sound individual nutritional advice.

Sian Porter RD also provided the same advice to the BBC in 2013: ‘Atkins and the never-ending battle over carbs’.2 Now, in 2017, here we trend again!

The high protein diet for weight loss has been making a comeback recently thanks to celebrity’s promotion from Kim Kardashian and actress Melissa McCarthy. According to an internet search on ‘high protein diet’ you will: • lose weight and tame hunger; • do your body good; • help with efforts to build muscle; • lose fat; • improve your sleep.

For full article references please email info@ networkhealth group.co.uk

The three popular high protein diets that are available for weight loss are the Dukan diet by Dr Pierre Dukan,3 the Atkins diet by Dr Robert Atkins,4 and the Paleolithic diet made popular

by Loren Cordain.5 These diets were first devised in the 1970s and have evolved over the past 40 years, yet, even today, they remain controversial with regards to long-term health. These diets promote a high dietary intake of protein

foods and encourage the complete omission, or a very low intake of other food groups, e.g. starchy carbohydrates, fruit, legumes and dairy.

HOW MUCH PROTEIN DO WE NEED?

DRVs for protein intake in the UK are set for different populations; the RNI for protein for adults ages 19-50 females and males is 45gm and 55gm daily respectfully.6 Daily RNI of protein as part of a balanced diet can be obtained from: 200mls of semi skimmed milk, 130gm of roasted chicken and four tablespoons of baked beans = 51gm.7 The majority of the UK’s free living adult population consume more than this amount on a daily basis.

HOW MUCH IS HIGH PROTEIN?

A Department of Health panel recommends a maximum amount of protein in a day for an adult to be no more than 1.5gm per kg, yet, there is insufficient evidence regarding this maximum amount. The Dietetic Manual states that over-consumption of protein above the maximum intake, offers no increased benefit in the body and may have certain health risks, e.g. kidney disease and osteoporosis.8 As well as the above high protein diets being advertised for weight loss, there are also food manufacturers that have launched their own range of high protein products. The number of products launched with an increase amount of protein added has increased by almost 40% in the last year and by www.NHDmag.com June 2017 - Issue 125

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WEIGHT MANAGEMENT 500% in the last five.9 Manufacturers or brands jumping on the protein bandwagon include Weetabix, GoNutrition, Shreddies, Special K, Arla (Dairy) and Weight Watchers. European labelling states that a food claim of ‘high in protein’ may only be made where at least 20% of the energy value of the food is provided by the protein.10 ARE THERE ANY ADVANTAGES OF HIGH PROTEIN DIETS IN WEIGHT LOSS?

Reduces hunger Speaking from dietetic consultations over 15 years, individuals following a high protein diet reported that protein foods helped with their satiety and reduced hunger. This made them less likely to over eat and snack in between meals thus reducing their overall calorie intake.

Reduces overeating and possibly binge eating on carbohydrate foods Consuming foods high in carbohydrate (e.g. bread, potatoes and pasta) resulted in eating larger amounts, admitting that it was easier to completely stop eating carbohydrates rather than reducing the portion size.

Shopping and eating out Shopping was quicker as you missed aisles.

Eating out in restaurants was easier on the high protein diet, as restaurants and cafes also offered more choices to the consumer.

Celebrity endorsement and another diet to try Individuals wanting to lose weight and ‘yo-yo’ diet for years, said that they were willing to trial any diet that had shown amazing physical results and were endorsed by famous people.

WHAT ARE THE DISADVANTAGES OF A HIGH PROTEIN DIET IN WEIGHT LOSS?

Unpleasant side effects Self-reported side effects from 429 participants following the Atkins diet showed that they suffered from the following side effects (highest incidence reported to the lowest): constipation, loss of energy, bad breath, difficulty concentrating and kidney problems including reduced kidney function. Also, heart-related problems were reported, including elevated serum cholesterol levels, plus gallbladder problems, gout, diabetes, and osteoporosis.11

Another study showed side effects following the Atkins diet were headaches, fatigue, depressed mood and hypoglycaemia.12 A dangerous side effect of the Dukan diet was a female aged 42 (no prior medical issues) who suffered 10 hours of nausea and vomiting secondary to ketoacidosis, whilst following the Dukan diet for two days.13 Difficult to get a correct balance of vegetable and animal protein and can be open to interpretation Individuals commencing on a high protein diet may not differentiate between processed meats and unprocessed meats, therefore, could actually be obtaining a large amount of protein from bacon, sausages, salami whilst also increasing salt and fat intake, leading to other potential health issues like cardiovascular disease and bowel cancer.

A lot of individuals do not like vegetable protein foods, e.g. beans, lentils, or do not know how to utilise them in their diet. Often, vegetable protein rich foods which are high in fibre, are often not included in the diet, thus consuming higher amounts of animal protein instead of vegetable protein. A large Meta-analysis looking at over 12,700 participants found that non meat eaters had significantly lower ischaemic heart disease mortality at 29% and an 18% reduced overall cancer incidence than meat eaters.14 The balance of vegetable and animal protein can affect long-term health.

Long-term adherence to a high protein diet can be difficult and could be expensive The high protein diets exclude other food groups, namely carbohydrates. One Atkins meal plan advises less than 20gm of carbohydrate daily.

Many individuals admit to coming off the diet and start eating carbohydrates again when they pass a bakery and/or go on holiday. Certainly, there are European holiday destinations where carbohydrates are the main staple of the diet, with foods including pizza, pasta, risotto, paella and continental fresh bread. This can make the high protein diet difficult to follow.

High protein labelled food products can be more expensive, Weight Watchers high protein wraps are priced at 23p each compared with Tesco white wraps at 11p each, making the high protein www.NHDmag.com June 2017 - Issue 125

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WEIGHT MANAGEMENT wraps nearly double the price.15 The three diet websites do not offer completely free information, for further advice payment is required.

May have an increase in calorie intake instead of a deficit and the diets and the high protein foods can be confusing Fat intake may also increase, due to the increased consumption in high protein foods, e.g. 100gm of nuts will provide 595kcals (about a third of an average female’s daily energy requirements).

The diet may also suggest using different cooking methods, e.g. frying steak which could also increase calorie intake.

Atkins and Dukan have developed over the years and both now have ‘phases’ which can be confusing to follow, the Dukan also has a ‘Nutritional staircase’! The Paleo diet has also changed over the years due to different author’s promotion, so may depend on which book you buy, or which website you go to.

High protein labelled foods, such as breakfast cereals or yoghurts, could also contain higher amounts of sugar, fat and calories when compared with the same brand non high protein cereal, thus leading to weight gain.There can be confusion surrounding labelling and consumers already are desperately trying to understand labels on products: low fat, low sugar, low salt, high in fibre; the ‘high protein’ claim on the label is merely adding to the confusion.

Free available meal plans will not suit every individual’s requirements There are basic meal plans with portion sizes available on the Atkins website for free, which will not suit everyone. The Paleo website also offers some free downloads; however, you have to pay for an individual plan on the Dukan website.

Nutritionally unbalanced An assessment of the food intake of females in Poland on the Dukan diet showed that they were high in animal protein, high in iron and vitamins A

and D. However, they were low in fibre, vitamin C and folate.16 Reported nutritional intake whilst on the Atkins diet, resulted in significant decreases in fibre intakes, decreased micronutrients such as non-haem iron, folate/folic acid, thiamine, magnesium, calcium, potassium and vitamin C. There were high intakes of vitamin A and D and phosphorus in the more restrictive low carbohydrate high protein diets.17 The paleo diet advocates omission of dairy, cereals, potatoes and legumes including peanuts. Following these diets long term will result in vitamin and mineral deficiencies and constipation.

WHAT ABOUT LONG-TERM HEALTH AND HIGH PROTEIN DIETS?

There is a cause for concern in individuals wanting to start a high protein diet with kidney disease, osteoporosis, and gastrointestinal conditions, e.g. constipation, diverticulitis and individuals with Type 2 diabetes. A low dietary intake of vegetable protein and a high intake of animal protein has been shown to have a negative effect on long-term health in relation to increasing body weight, an increase prevalence of diabetes Type 2 and higher LDL cholesterol levels. This was found in the Adventist study looking at the diets of over 60,000 adults.18 CONCLUSION

As dietitians, it is our role to explain the disadvantages and contraindications to individuals about the high protein diet used for weight loss. Despite the possible unpleasant and even dangerous side effects of a high protein diet, they continue to be publicised positively and are aimed at anyone wanting to lose weight.

The three examples in this article of high protein diets would not earn half as much money if an internet search revealed honest examples of what the diet can do to the body.

There remains to be no current evidence for superiority with weight loss on a high protein diet and should be actively discouraged.

For further information on diet trends: How to lose weight well presented by Dr Chris Van Tullekan and RD Hala El-Shafie: www.channel4.com/ programmes/how-to-lose-weight-well Information about the Diet Composition of the Paleolithic Diet and evidence summary, see the PEN website www.pennutrition.com/KnowledgePathway.aspx?kpid=23246&trid=23440&trcatid=2 36

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