Healthy Aging | Dr. Jeffrey Tucker

Healthy Aging article by Dr. Tucker

By DrTucker 27 Feb, 2013 Articles by Dr. Tucker, Blog Healthy Aging, part 1, www.DrJeffreyTucker.com

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56381

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Cholesterol and Statins

By DrTucker 15 Nov, 2012 Blog, Healthy Aging, Heart Health cholesterol, dementia, Healthy Aging, Statins, www.DrJeffreyTucker.com

I don’t worry as much about people’s cholesterol level, I worry about their overall risk of heart disease. Too many practitioners are fixed on just LDL cholesterol and this leads to the overuse of statin drugs.

There are two common treatment approaches:

1) “Treat-to-target”–an approach that uses statins to force LDL cholesterol to less than 70 for high-risk patients and no higher than 130 for people not at risk
2) “Tailored treatment”–an approach that gives far less importance to LDL level, while weighing multiple risk factors to develop a variety of treatments including exercise, diet modification, etc.

Tailored treatment will prevent more coronary artery disease events while treating fewer people with high-dose statins.

Years ago, the Framingham Heart Study showed that total cholesterol levels below 160 caused heart disease problems to RISE! So it’s been well known for decades that low lower lowest is not good better best.

There is research on subjects in their 70’s that found elevated levels of total cholesterol were linked with REDUCED dementia risk in their later 70s. And elevated cholesterol throughout their 70s was associated with reduced dementia risk throughout their 80s.

Let’s talk about natural alternatives to the high cholesterol issue and reducing the risk of dementia as we age.

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New understandings about adult protein needs

By DrTucker 31 Jul, 2010 Healthy Aging, Nutrition, Osteoporosis aging, amino acids, diabetes, diet, Healthy Aging, muscle strength, Osteoporosis, protein, protein metabolism, protein requirements, Type 2 diabetes, weigh loss, www.drjeff, www.DrJeffreyTucker.com

This article substaniates why I recommend OptiCleanse GHI from Xymogen & UltraMeal from Metagenics as important protein shakes

Donald K Layman Department of Food Science & Human Nutrition, University of Illinois, Urbana, IL 61801, USA

Nutrition & Metabolism 2009, 6:12doi:10.1186/1743-7075-6-12

The developing controversy about Dietary Guidelines for protein stems from current perceptions that protein intakes above minimum requirements have no benefit and may pose long-term health risks. These beliefs are largely based on assumptions and extrapolations with little foundation in nutrition science. Diets with increased protein have now been shown to improve adult health with benefits for treatment or prevention of obesity, osteoporosis, type 2 diabetes, Metabolic Syndrome, heart disease, and sarcopenia [1–4].

During the past decade a growing body of research reveals that dietary protein intakes above the RDA are beneficial in maintaining muscle function and mobility [6] and in the treatment of diseases including obesity, osteoporosis, type 2 diabetes (T2DM), Metabolic Syndrome (MetS), heart disease, and sarcopenia [1–4]. The new research establishes health benefits and provides molecular evidence of numerous metabolic outcomes associated with protein intake or amino acid metabolism that are not reflected in the traditional measure of nitrogen balance. These outcomes include cell signaling via leucine [7,8], satiety [9,10], thermogenesis [11], and glycemic control [12,13]. The dietary protein necessary to optimize each of these metabolic outcomes is not reflected in measures of nitrogen balance and is not represented within the current concept of the minimum RDA. So what is known and what is missing in current Dietary Guidelines?

The efficiency of protein utilization decreases throughout adult life [6]. During aging, there is an increase in the requirement for EAA to produce a positive response in muscle protein synthesis [16,17]. The need for total protein may not change, but the effectiveness of amino acids to stimulate muscle (and probably bone) protein metabolism decreases requiring either more total protein or greater nutrient density of EAA/total protein (i.e. protein quality). The change in efficiency of EAA use appears to be associated with the loss of anabolic drive for development of lean tissue [18]. During growth, the body has a high metabolic priority for structural development of muscle and bone driven by anabolic hormones including insulin, growth hormone, IGF-1 and steroid hormones. Further, physical activity has a positive effect on the efficiency of use of amino acids [19]. Muscle protein synthesis is stimulated by stretching and resistance activity. The converse is also true; a sedentary lifestyle reduces the efficiency of EAA use. After approximately age 30 y, the anabolic drive is lost; basal levels of hormones become largely ineffective in stimulating protein synthesis in structural tissues; and diet quality and physical activity become the limiting factors for maintaining optimal protein turnover for repair, remodeling, and recovery.

In summary, omissions in current understanding of dietary protein needs are that 1) nitrogen balance and amino acid oxidation are only useful for defining minimum protein requirements and not optimum amino acid needs, 2) protein requirement is proportional to body weight and inversely proportional to energy intake, and 3) adults need more EAA than children to maintain the efficiency of protein turnover in structural tissues.

New knowledge about protein

Protein and amino acids contribute to multiple metabolic roles …Dietary protein influences cell signaling, satiety, thermogenesis and glycemic regulations and each of these roles is initiated by increases in plasma and intracellular amino acid concentrations.

Most adults consume less than 10 g of protein at breakfast [23,24] (Figure 1). In children and young adults, uneven meal distribution of protein appears not to adversely affect growth. The anabolic drive maintains high efficiency of protein use for nitrogen retention even when daily protein is consumed as a single large meal. However in older adults, the quantity and quality of protein at individual meals is important. Adults require a minimum of 15 g of EAA or at least 30 g of total protein to fully stimulate skeletal muscle protein synthesis [21,25]. This response appears to be determined by the EAA leucine which serves as a critical signal for triggering initiation of muscle protein synthesis. Leucine has been well characterized as a unique regulator of the insulin-mTOR signal pathway controlling synthesis of muscle proteins [7,8]. In children and young adults, this signal pathway is regulated by insulin and dietary energy while leucine regulates the pathway in adults [26]. Current dietary patterns that provide adequate protein or leucine at only one meal produce an anabolic response only after that meal (Figure 1). This is a critical factor for protection of lean tissues during weight loss or to prevent age-related sarcopenia and osteoporosis.

Figure 1. Protein distribution at meals. A) Ingestion of 90 grams of protein, distributed evenly at 3 meals. B) Ingestion of 90 grams of proteins unevenly distributed throughout the day. Stimulating muscle protein synthesis to a maximal extent during the meals shown in Figure 1A is more likely to provide a greater 24 hour protein anabolic response than the unequal protein distribution in Figure 1B. (Adapted from Paddon-Jones & Rassmussen Curr Opin Clin Nutr Metab Care 2009, 12: 86–90.)

The meal content of protein is also a key factor for satiety and appetite regulation [9,10]. Protein has greater satiety value than either carbohydrates or fats and reduces food intake at subsequent meals [27]. Studies of energy regulation for weight management show that replacing carbohydrates with protein reduces daily energy intake by ~200 kcal [9]. The mechanism for this satiety effect may be mediated by intestinal hormones or by reducing peak post-prandial insulin response. While the mechanism remains to be elucidated, it is clear that the improved satiety response requires >30 g of protein at a meal and that breakfast has the greatest impact on total daily energy intake [27]. As with protein turnover in muscle and bone, limiting protein intake to a single large meal late in the day reduces the satiety benefits of dietary protein [22].

The most unequivocal evidence for the benefit of increased dietary protein is derived from studies of weight management [1,28,29]. Diets with increased protein have been shown to be highly beneficial during weight loss because of their ability to correct body composition and increase satiety and thermogenesis. Higher protein diets increase loss of body weight and body fat and attenuate loss of lean tissue when compared with commonly recommended high carbohydrate low fat low protein diets [28,30]. Clearly, the major factors accounting for weight loss are the magnitude of energy restriction and individual compliance. Any diet can produce weight loss. However, long-term success with weight loss relates to maintenance of metabolically active lean tissues and research has proven that higher protein diets protect muscle and bone during weight loss. Use of conventional high carbohydrate, low fat, low protein diets results in 30% to 40% loss of lean tissue mass. Use of higher protein diets reduces lean tissue loss to <15% and when combined with exercise can halt loss of lean tissue during weight loss [30–32]. Studies also show that moderate protein diets have better long-term compliance.

The effects of protein for maintaining lean tissues appear to translate into health benefits during aging where progressive loss of structural strength and mobility are critical factors. Osteoporosis and sarcopenia have emerged as major issues during aging [2,3]. Prevention of osteoporosis is associated with physical activity and dietary calcium and protein [3]. The efficacy of calcium and protein are interrelated [3]. Calcium supplements are largely ineffective for remodeling of bone matrix if protein is limiting. Positive effects of calcium appear to require intakes of protein >1.2 g/kg to have beneficial effects. The long-held belief that increased dietary protein could cause bone loss as reflected in increase urinary calcium is incorrect [33] and protein is now recognized to increase intestinal calcium absorption in addition to enhancing bone matrix turnover [34].

Similar results have been observed with studies of muscle health in elderly where the efficiency of EAA use is reduced [16,17]. The level of EAA required to stimulate muscle protein synthesis is increased in part due to reduced anabolic stimulus of hormones.

Early research with MetS evaluated reducing dietary carbohydrates with fats [36]. While increasing dietary fats improved glycemic control and reduced cardiovascular disease (CVD) risk, the prospect of increasing dietary fat remains controversial. Replacement of carbohydrates with protein improves glycemic control measured as reduced post-prandial hyperinsulinemia [37] and in T2DM corrects hyperglycemia and HbA1c [13]. Equally important, reduced carbohydrate diets have decreased TAG, increased HDL and increased LDL particle size (i.e. LDL-C/ApoB) improving the dyslipidemia commonly associated with T2DM and MetS [4]. These conditions are 4-times more important for heart disease and all cause mortality than elevated cholesterol or LDL concentration [38].

New understandings about protein for the Dietary Guidelines

• Protein is a critical part of the adult diet

Protein should be a central part of a complete diet for adults. While physical growth occurs only for a brief period of life, the need to repair and remodel muscle and bone continues throughout life. Protein needs become more important during periods of reduced food intake such as weight loss or during periods of recovery after illness or during aging.

• Protein needs are proportional to body weight; NOT energy intake

Protein needs for adults relate to body weight. The acceptable protein range is 10% to 35% of total energy. However, protein needs are constant across all energy intakes. So at low energy intakes, protein needs to be a higher percentage of total calories and at high energy intakes protein can be reduced as a percentage of total calories. In general, dietary protein should be established first in any diet in proportion to body weight and then carbohydrates and fats added determined by energy needs.

• Optimal adult protein use is a function of intake at individual meals

Protein is an important part of good nutrition at every meal. Vitamins and minerals can fulfill nutrient needs on a once-per-day basis but for protein the body has no ability to store a daily supply. To maintain healthy muscles and bones for adults, at least 30 g of protein should be consumed at more than one meal. Breakfast is an important meal for dietary protein because the body is in a catabolic state after an overnight fast. A meal with at least 30 g of protein is required to initiate repletion of body proteins. Protein at breakfast is also critical for regulation of appetite and daily food intake.

• Most adults benefit from protein intakes above the minimum RDA

Aging populations confront increasing incidence of obesity, osteoporosis, type 2 diabetes, Metabolic Syndrome, heart disease, and sarcopenia which have raised new questions about dietary ratios of carbohydrates, fats, and protein for life-long health. The RDA represents the minimum daily intake for active healthy adults. For most adults, replacing some dietary carbohydrates with protein will help to maintain body composition and mobility, improve blood lipids and lipoproteins, and help to control food intake.

References

Paddon-Jones D, Westman E, Mattes RD, Wolfe RR, Astrup A, Westerterp-Plantenga M: Protein, weight management, and satiety. Am J Clin Nutr 2008 , 87:1558S-1561S. PubMed Abstract | Publisher Full Text Return to text
Paddon-Jones D, Short KR, Campbell WW, Volpi E, Wolfe RR: Role of dietary protein in the sarcopenia of aging. Am J Clin Nutr 2008 , 87:1562S-1566S. PubMed Abstract | Publisher Full Text
aney RP, Layman DK: Amount and type of protein influences bone health.
Am J Clin Nutr 2008 , 87:1567S-1570S. PubMed Abstract | Publisher Full Text Return to text
Layman DK, Clifton P, Gannon MC, Krauss RM, Nuttall FQ: Protein in optimal health: heart disease and type 2 diabetes.

Am J Clin Nutr 2008 , 87:1571S-1575S. PubMed Abstract | Publisher Full Text

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