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Minggu, 12 Juni 2016

40g Casein Build Lean Muscle Overnight: 27% Elevated MPS Even W/Out Training (30% W/ Ex) - And That in 70-Y+ Olds!

Pre-bed protein (meal or shake) is always a good idea, no matter if you're young or old, if you work out in the PM or not - you don't want to miss the increased overnight protein synthesis.
Gaining muscle over night? No news! You will probably remember the two previous articles on "pre-bed protein ingestion", i.e. "12-Week Study: 25g Bed-Time Protein Almost Doubles Size & Increases Strength Gains" (read it) and "3.2kg of Lean Mass Over Night W/ 40g of Slow Digesting Protein 30min Before Bed!? Over One Year, a Positive Nitrogen Balance and +20% FSR Could Make It Happen!" (read it), but still! With this being the first study to show that even (on average) 71-year-olds can "build muscle overnight" with nothing but 40g of casein being ingested ~30 minutes before they went to bed, it is probably the most impressive of the previously referenced studies.
High-protein diets are much safer than the mainstream say, but there are things to consider...

Practical Protein Oxidation 101

5x More Than the FDA Allows!

More Protein ≠ More Satiety

Protein Oxidation = Health Threat

Protein Timing DOES Matter!

More Protein = More Liver Fat?
There is, allegedly, no long-term data (=actual gains) such as the increase in lean mass after 6-12 weeks, but with this study, which was actually designed to test the hypothesis that...
"[...] that physical activity can augment the impact of presleep protein ingestion on overnight muscle protein synthesis [in] 23 older men (71 6 1 y) who ingested 40 g casein protein intrinsically labeled with L-[1-13C]-phenylalanine and L-[1-13C]-leucine before going to sleep with (PRO+EX8; n = 11) or without (PRO; n = 12) a bout of physical activity being performed earlier in the evening" (Holwerda. 2016),
the study results (that were, by the way, only marginally in line with the scientists hypothesis from the previously cited introduction) exceed my personal expectations, significantly.
Figure 1: Overnight myofibrillar protein FSRs after PRO+EX (n = 11) or PRO (n = 12) presleep treatment in older men as calculated with L-[ring-2H5]-phenylalanine (A) or L-[1-13C]-leucine (B) as tracer. Values are means 6 SEMs. Data were analyzed with an unpaired Student s t test. *Different from PRO, P , 0.01. FSR, fractional synthetic rate; PRO, 40 g protein in rested state; PRO+EX, 40 g protein after resistance-type exercise (Holwerda. 2016)
Before we start discussing the results, though, let's take a look at what the authors of the study actually did: After their subjects had ingested the 40g of labelled casein (I cannot tell if that was micellar casein, but I can tell you that the scientists got it on the free market and that it was produced by Dr. Oetker, Germans and countrymen of the Dutch scientists will know the company), the authors measured the subjects' overnight protein digestion and absorption kinetics and myofibrillar protein synthesis rates by combining primed, continuous infusions of L-[ring-2H5]-phenylalanine, L-[1-13C]-leucine, and L-[ring-2H2]-tyrosine with the ingestion of intrinsically labeled casein protein.
Suggested Read for everyone w/ parents and grandparents: Creatine Will Protect Grandpa's Muscle Even if He Doesn't Train!? More Reasons "E-veryone" Could Take Creatine | more
What did the workouts look like? As you may have gathered by now only the PRO+EX group worked out before going to sleep at the lab. Here's what they did (keep in mind: the average age was 70 years!): "The physical activity protocol consisted of 60 min of moderate-intensity, lower-body, resistance-type exercise. After 15 min of self-paced cycling at 100 W with a cadence of 60–80 rpm, subjects performed 6 sets of 10 repetitions on the horizontal leg press machine (Technogym BV) and 6 sets of 10 repetitions on the leg extension machine (Technogym BV). The first 2 sets of both exercises were performed at 55% and 65% 1RM, respectively, and sets 3–6 were performed at 75% 1RM. Subjects were allowed to rest for 2 min between all sets" (Holwerda. 2016).
As the results in Figures 1-2 clearly indicate, the relatively high amount of protein ingested before sleep was
  • normally digested and absorbed, with 54% ± 2% of the protein-derived amino acids appearing in the circulation throughout overnight sleep, and
  • significantly boosted the overnight myofibrillar protein synthesis rates
In that, the increase in MPS was +31% (0.058% ± 0.002%/h compared with 0.044% ± 0.003%/h; P < 0.01; based on L-[ring-2H5]-phenylalanine) with exercise and at least +27% (0.074% ± 0.004%/h compared with 0.058% ± 0.003%/h; P < 0.01; based on L-[1-13C]-leucine) without exercise.
Figure 2: Eventually, it's the net balance that counts and this is where training provided a non-significant, but potentially still relevant difference (see Figure 3 for tracer incorporation) in the elderly subjects of the study at hand (Holwerda. 2016).
Accordingly, more dietary protein-derived amino acids were eventually incorporated into de novo myofibrillar protein (~new muscle mass) during overnight sleep in the PRO+EX than in PRO treatment (0.042 ± 0.002 compared with 0.033 ± 0.002 mole percent excess; P < 0.05).

This difference between the actual amount of the traced amino acids that ended up in the muscle, was not just statistically significant (see Figure 3, in bottom line). The 10% vs. 20% difference between the PRO and the PRO-EX group is also of potential practical relevance as it increased from - over weeks the muscle gains in the PRO-EX group can thus be expected to be significantly larger. Damas et al. (2016) have, after all, been able to show only recently that the (logical) correlation between acute increases in protein synthesis and lean muscle gains that has previously been doubted does exist - if you account for muscle damage (which is reduced after 1-3 weeks of training).
Figure 3: The incorporation of traced aminos shows that the advantage of working out before sleep may matter.
Bottom line: While working out pre-bed may be best, Holwerda et al. have proven that granny & grandpa will unquestionably benefit from consuming 40g of slow-digesting casein protein (probably micellar casein) 30 minutes before going to bed - "post-workout", or not.

With additional exercise, the net protein accrual, i.e. the actually relevant difference between the amount of amino acids that is eventually incorporated into the muscle and not broken down will be 20% higher (Figure 3), though - a stat. sign. and potentially relevant difference, neither your grand parents, nor you should miss. So what? Train - hit the weights at 2-5 (max!) times a week and inspire the rest of your family to do the same | Comment on Facebook!
References:
  • Damas, Felipe, et al. "Resistance training‐induced changes in integrated myofibrillar protein synthesis are related to hypertrophy only after attenuation of muscle damage." The Journal of physiology (2016). Read the SuppVersity article about this study.
  • Holwerda. "Physical Activity Performed in the Evening Increases the Overnight Muscle Protein Synthetic Response to Presleep Protein Ingestion in Older Men." First published June 8, 2016, doi: 10.3945/​jn.116.230086 J. Nutr. jn230086.

Minggu, 22 Mei 2016

Food Proteins Have Same Muscle Building + Fat Shredding Effects as Whey Protein Shakes, and Reduces Desire to Eat

What's more muscle ana & fat catabolic?
It is not too long ago that I've written about the results of the first PRISE study (Arciero. 2014) on Facebook. In said study, the subjects, your average overweight to obese individuals, had been advised to use a protein-pacing strategy (P; six meals/day @ 1.4 g/kg body weight (BW), three of which included whey protein (WP) supplementation) combined with a sane multi-mode fitness program consisting of resistance, interval sprint, stretching, and endurance exercise training (RISE) to improve their composition - with quite astonishing results, by the way (Arciero. 2014).

More specifically, the subjects in the PRISE (vs. RISE = only exercise) arm of the study lost more more body weight (3.3 ± 0.7 vs. 1.1 ± 0.7 kg, P + RT) and fat mass  (2.8 ± 0.7 vs. 0.9 ± 0.5 kg, P + RT) and gained (P < 0.05) a greater percentage of lean body mass (2 ± 0.5 vs. 0.9 ± 0.3 and 0.6 ± 0.4%, P + RT and P, respectively | read old FT).
Yes, the high protein intake clogged the liver during overfeeding

Are You Protein Wheysting?

5x More Than the FDA Allows!

More Protein ≠ More Satiety

Protein Oxidation = Health Threat

Protein Timing DOES Matter!

More Protein = More Liver Fat?
The purpose of Arciero's newest study was now to "extend these findings and determine whether protein-pacing with only food protein (FP) is comparable to WP [whey protein] supplementation during RISE training on physical performance outcomes in overweight/obese individuals" (Arciero. 2016). To this ends, the scientists recruited thirty weight-matched volunteers who were prescribed either RISE training and a P diet derived from whey protein supplementation (WP, n = 15) or RISE training a P diet  with food protein being the major protein sources (FP, n = 15) for 16 weeks. Both interventions involved the previously discussed ingestion of six small meals, each day containing ~20–25 g of a high quality protein source.
Table 1: Sample Menus from the FP and WP nutritional intervention diet plans during the 16 week PRISE intervention. Menus were similar in macronutrient distribution (Arciero. 2016).
As you can see in Table 1, the sources of said 20-25g of protein differed significantly between groups; with eggs, greek yogurt, fish, poultry, beef, cottage cheese and other natural and rather slow- digesting protein sources replacing the fast-digesting whey protein (Classic Whey; Optimum Nutrition) from the previous study / in the current whey protein arm of the study.
"For all meals, participants were provided with a menu of foods from which to choose. Examples included milk, Greek yogurt, eggs, lean meats, fish, poultry, and specific plant sources, including legumes, nuts, and seeds. The number of recommended daily calories to consume was estimated to match the caloric requirements of each individual as measured by resting metabolic rate and measured/estimated physical activity level but was ad libitum, and not energy-restricted. Both groups followed the same protocol in terms of the timing of meals: all meals were evenly spaced throughout the day and one meal was consumed within one hour of waking in the morning and another two hours prior to bed. On exercise days, both groups consumed a protein meal (20–25 g) within 60 min [PWO, as bros'd call it ;-] after completion of exercise. For WP, they were required to consume this meal as 20–25 g of whey protein giving them a total of three servings of whey on exercise days. For FP, this required a protein-rich food meal of 20–25 g. On non-exercise days, both groups consumed similar amounts of total protein at each of their six meals per day" (my emphasis in Arciero. 2016).
Needless to say that all subjects in both groups participated in the same multiple exercise training regimen as described previously (Arciero. 2014). Briefly:
  • Figure 1: CONSORT (Consolidated Standards of Reporting Trials) flow chart of participants during the study intervention (Arciero. 2016).
    The training program consisted of four specific types of exercise: (1) resistance training; (2) interval sprints; (3) stretching/yoga/pilates; and (4) endurance exercise (RISE training; Supplementary Materials Table S2). 
  • Subjects underwent four exercise sessions / week, and the sessions rotated through the four types of exercise, such that each of the four exercises was performed one day/week. 
  • The resistance (R) training sessions were completed within 60 min and consisted of a dynamic warm-up, footwork and agility, lower and upper body resistance, and core exercises performed at a resistance to induce muscular fatigue in 10–15 repetitions and for two to three sets (in other words: they trained to failure). 
  • A 30 s recovery was provided between sets and a 60 s recovery was allowed between different exercises (and they still grew | cf recent post on short rest). 
  • The sprint interval (I) training sessions were completed within 40 min and consisted of 5–10 sets of 30–60 s of all-out exercise (remember "all-out" for an overweight untrained individual is miles away from "all-out" for an athlete, though) interspersed with 2–4 min of rest after each exercise. Participants were allowed to perform the sprints using any mode of exercise (treadmill, elliptical machine, stationary bikes, swimming, snowshoeing, cycling, rollerblading, etc.). 
  • The stretching/yoga/pilates regimen was based on traditional yoga poses with modern elements of pilates training for a total body stretching, flexibility, and strengthening workout. All sessions were completed within 60 min and were led by a certified yoga instructor (PJA). It should be pointed out that it is not clear how important this part of the regimen was, but previous research indicates that yoga can actively reduce the ill effects of chronically elevated cortisol down (Kamei. 2000) and may thus help restore the natural "downs", which are required for the fat burning (yes, you read me right!) cortisol spikes. 
  • Finally, endurance exercise training was performed for 60 min or longer at a moderate pace (60% of maximal effort). Participants were allowed to choose from a variety of aerobic activities, including walking, jogging, cycling, rowing, swimming, etc. 
To make it easier to grasp, I've included a tabular overview of the workout in Table 2 of this article. Here, RPE is, as usually the rating of perceived effort; C the choice of exercise modality; WB whole body exercises; S is stretching exercise; and the Xs, are exercise days. Ah, and not to forget, the  Exercise modalities available for C aka cardio were running, cycling, swimming, elliptical, rowing, cross-country skiing, etc.
Table 2: Overview of the subjects' workout schedule (Arciero. 2016).
While the subjects' body weight was obtained during each visit with a standard digital scale (Befour Inc., Cedarburg, WI, USA), their body composition was assessed by Dual Energy X-ray Absorptiometry (iDXA; Lunar iDXA; GE Healthcare, Madison, WI, USA; analyzed using Encore software version 13.6; GE Healthcare). For the twenty-one participants who completed the intervention (WP, n = 9; FP, n = 12), the measures of body composition I plotted for you in Figure 2 can thus be considered highly reliable:
Figure 2: Changes in body composition fro pre- to post-study (Arciero. 2016)
As you can see, the body composition and the physical performance (Figure 3) significantly improved in both groups, regardless of whether the protein came from fast digesting leucine-packed whey protein or common (albeit high essential amino acid aka EAA food sources | p < 0.05 for the effect on performance and body comp, not the inter-group difference!).
Is this for athletes, too? The scientists think so, read their 2015 review of the literature discussing why "PRISE" may benefit not just the biggest loser, here - for FREE (Arciero. 2015)!
Now, this is not exactly surprising, what may come as an unwanted surprise for the protein supplement industry, though, is the fact that there was no effect of protein source on either the changes in body composition - including the reduction in visceral fat, where the "whey advantage" does yet point to a potential benefit of increased GLP-1 levels in response to fast(er) digesting proteins (read further to learn more reasons).
Figure 3: Pre-/post values of the most relevant performance markers assessed in the study (Arciero. 2016)
As the authors point out, there were likewise no significant differences in the performance markers (see Figure 3) or the health-relevant markers of cardiometabolic disease risk (e.g., LDL (low-density lipoprotein) cholesterol, glucose, insulin, adiponectin, systolic blood pressure), which significantly improved (p < 0.05) to a similar extent in both groups.

The reason it is still worth taking a closer look at the latter is that the higher baseline insulin and triglyceride levels in the whey protein group (171.8 ± 29.8 vs. 94.2 ± 8.5 mg/dL and 21.7 ± 10.5 vs. 9.6 ± 2.3 μg/dL, respectively) could explain the higher visceral fat loss despite identical food and protein (1.6-1.7g/kg) intakes in the whey protein group (see Figure 2) - at least some of the subjects who had been randomly assigned to the were simply significantly more metabolically deranged.
Compared to whey protein, food proteins suppress hunger more effectively (Arciero. 2016).
So what? Well, there's little doubt that the scientists' conclusion that their "results demonstrate that both whey protein and food protein sources combined with multimodal RISE training are equally effective at improving physical performance and cardiometabolic health in obese individuals" (Arciero. 2016) is accurate and not debatable.

That obviously does not mean that you cannot or should no longer use your protein powders (whey studies). What the results do indicate, though, is that previously untrained individuals (confirmation in athletes is warranted) are not missing out on performance gains or improvements in body composition if they cover their protein needs with regular high protein foods instead of supplemental whey protein - regardless of its faster digestion and higher leucine levels.

There's yet more: A brief glance at the figure to the right suggests that some people may even benefit from ditching the fast digesting, insulin spiking whey protein, due to the superior effect of "real" (= food) protein on hunger / your desire to eat, which was not sign., but measurably higher wit whey compared to "real" food protein in the study at hand | Comment!
References:
  • Arciero, Paul J., et al. "Timed-daily ingestion of whey protein and exercise training reduces visceral adipose tissue mass and improves insulin resistance: the PRISE study." Journal of Applied Physiology 117.1 (2014): 1-10.
  • Arciero, Paul J., Vincent J. Miller, and Emery Ward. "Performance Enhancing Diets and the PRISE Protocol to Optimize Athletic Performance." Journal of nutrition and metabolism 2015 (2015).
  • Arciero, Paul J., et al. "Protein-Pacing from Food or Supplementation Improves Physical Performance in Overweight Men and Women: The PRISE 2 Study." Nutrients 8.5 (2016): 288.
  • Kamei, Tsutomu, et al. "Decrease in serum cortisol during yoga exercise is correlated with alpha wave activation." Perceptual and motor skills 90.3 (2000): 1027-1032.

Rabu, 18 Mei 2016

Can Oxidized Proteins Kill You? PROTOX Links Processed High Protein Foods to IBS, Diabetes, Cancer, NAFLD & Co.

Dietary protein sources: You better eat them before they're rancid.
There's such a thing as "protein oxidation"? If you are asking yourself this question, you will probably have missed the 20th century studies by Henry D. Dakin (*1880–†1952). Dakin originally reported the oxidative degradation of particular amino acids during digestion and introduced the potential biological consequences of such biochemical reactions.

The impact of PROTOX, as this form oxidation is called to distinguish it from the way better known LOX (lipid oxidation) on human health was, at that moment, wholly unknown.

As Estévez and Luna point out in a recent paper in the peer-reviewed scientific journal "Critical Reviews in Food Science and Nutrition", PROTOX has been in the focus during the succeeding decades, though, "owing to the association between the oxidative damage to proteins and aging and age-related diseases (Berlett & Stadtman, 1997)" (Estévez. 2016).
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Earl R. Stadtman (*1919–†2008), a renowned biochemist of the 20th century and mentor of various Novel-prized scientists, was one of the pioneers in unveiling the chemistry and biological consequences of PROTOX. From the elucidation of mechanisms whereby the rates of metabolic reactions match to the necessities of the living cell, he identified the connection between unbalanced oxidative metabolism (≈ oxidative stress) and impaired physiological processes (Stadtman, 1990).
Figure 1: Oxidative damage to poultry: Sources of oxidative stress, impact of oxidation, and antioxidant strategies (Estévez. 2015).
"While some of the underlying mechanisms of the connection between in vivo PROTOX and disease are still to be clarified, it is accepted that PROTOX plays a role in aging and age related diseases such as Alzheimer’s, Parkinson’s, inflammatory Bowel’s (IBD), rheumatoid arthritis, diabetes, muscular dystrophy, and cataractogenesis, among others (Berlett & Stadtman, 1997). 
On account of the effort of brilliant scientists, the ‘poor cousin’ of lipid oxidation is now extolled as a topic of the utmost scientific interest" (Estévez. 2016).
Now that you know all that, I suspect that you are asking yourself what this "protein oxidation" has to do with "Food Science and Nutrition". Well, the answer is actually pretty simple: While PROTOX has been for decades disregarded as a major cause of food deterioration, it does play a major role in foods from nutritional, sensory and technological points of view.
Note: There will be a follow up to this article, next week with answers to your questions, such as (1) How can I avoid protein oxidation when preparing protein containing meals? (2) Which foods are the most susceptible? (3) If processing is an issue won't protein powders be the worst offenders? Not your question? Feel free to post additional questions you may have here.
In the early years of the 21st century, numerous subsequent studies shed light on the oxidative modifications undergone by muscle proteins during handling, processing and storage of muscle foods; and among of the better known results of these studies are...
Figure 2: Hypothesis of the influence of dietary protein oxidation on in vivo oxidative stress and pathological conditions. "It is actually well-established that the composition of food and the dietary habits have physiopathological consequences" (Estévez. 2016).
  • that the formation of PROTOX will impair the functionality and digestibility of meat and dairy proteins (Santé-Lhoutellier et al., 2007; Feng et al., 2015),
  • that the presence of PROTOX will impair the nutritional value and sensory attributes of muscle foods such as tenderness (Bao & Ertbjerg, 2015) and flavor (Villaverde et al., 2014), and the chemistry behind food PROTOX, the occurrence and consequences of PROTOX during food
  • that PROTOX will almost inevitably occur during storage and processing, but can be reduced by applying certain strategies (Bekhit et al., 2013; Estévez, 2015; Soladoye et al., 2015).
As Estévez and Luna point out, the investigation of postprandial events, which has started, only recently, "enables a more realistic approach to investigate the impact of food intake on nutrition and health as food components are severely modified during the digestion phases" (Estévez. 2016). Unfortunately, many of the currently existing studies investigated events in-vitro. The important (and certainly most relevant) question, whether the consumption of oxidized proteins from food can actually harm you, however, has been addressed by a limited number of studies, only.
How to prevent protein oxidation? There's no way you prevent the oxidation of proteins in food completely, but packaging in light-blocking low-oxygen containers and not processing foods like crazy (exerting force on it in a grinder, for example | see Figure, right. Bao. 2015) could reduce the oxidation process just as significantly as not heating / burning meat will (Villaverde. 2013).
There's, nevertheless, "evidence that in vivo oxidation is a source of aging and disease calls to elucidate to which extent dietary oxidative stress contributes to aggravating in vivo oxidative stress and its harmful consequences" (Estéves. 2015); and these "harmful consequences" have been traced back to particular dietary oxidation products, of which researchers believe that they are able to induce or contribute to some pathological process in targeted cells or tissues through the induction of specific molecular responses (i.e. gene expression regulation).
  • Figure 2: Proposed mechanisms of pathogenesis exerted by dietary protein oxidation products. It was not until recently that the fact that dietary oxidized proteins would, themselves, be active executors of specific pathological processes was discovered (Estévez. 2016).
    the intake of foods high in PROTOX products, raises general oxidation markers, leads to cell damage and increases the risk of suffering health disorders such as coronary-heart diseases, neurodegenerative disorders and certain types of cancer (Esterbauer et al., 1992, 1993; Sies et al., 2005; Awada et al., 2012), 
  • interestingly, these processes have been linked to LOX products, as well, which turn out to be cross-linked to the cytotoxicity and mutagenicity potential of PROTOX species on the gastrointestinal tract or in internal organs upon absorption (Esterbauer et al., 1993), 
  • proteins are regarded as targets for post-translational changes, unlike LOX of which we believe that they have a direct damaging effect
  • the molecular basis of these processes commonly involves the interaction of primary and secondary LOX products (i.e. alkyl radicals, peroxides, hexanal, 4-HNE, MDA) with proteins of biological significance (formation of adducts) and other biomolecules such as DNA (Esterbauer et al., 1991; Awada et al., 2012).
  • cellular responses to these molecular changes usually imply the activation of particular signalling pathways that involves gene expression and/or suppression (Figure 2), 
Now, while all of this has been known for years, it was not until recently that the fact that dietary oxidized proteins and PROTOX products would, themselves, be active executors of specific pathological processes was discovered.
"The oxidation of food proteins during processing and storage leads to the inexorable accumulation of oxidation products that will be primary exposed to the gastrointestinal tract. As aforementioned, food PROTOX also occurs during consumption and gastrointestinal digestion increasing the concentration of oxidation products in the lumen. Scientific evidences support the impact of dietary oxidized proteins on intestinal flora disturbance, the redox state of intestinal tissues and the onset of local pathological conditions (Keshavarzian et al., 2003; Fang et al., 2012; Xie et al., 2014). 
Pierre et al. (2004), among others, already provided reasonable arguments to support the impact of luminal oxidative stress on cytotoxicity, genotoxicity and apoptosis in cells from colonic mucosa. More specifically, oxidative stress has been found to play a relevant role in the onset of carcinogenic processes, including CRC (Polyak et al., 1997; Valko et al., 2006). Interestingly, some clinical studies emphasize the extent of plasma protein carbonylation as a reliable marker of the risk of suffering CRC (Yeh et al., 2010; Chang et al., 2008). Chang et al. (2008) in particular, found altered protein carbonyl levels in CRC patients while LOX products remained at low levels. Others implicate the oxidative damage to proteins in the pathogenesis of CRC. This is the case of Nedic et al. (2013) who indicated the potential role of the carbonylation of insulin-like growth factor-binding proteins in CRC growth" (Estévez. 2016).
While the formerly cited evidence is mostly from in vitro studies, more recent data from rodents shows that intraperitoneal administration (= injection that is equivalent to oral consumption) of oxidized proteins to rats raised the level of advanced oxidation protein products )AOPPs) in the local intestine tissue and in blood inducing intestine epithelial death through a redox-dependent
pathway. As Estévez and Luna rightly point out, "[t]hese results proven that PROTOX products may be implicated in the transfer of oxidative stress from the luminal phase to the lamina propia of the intestinal mucosa facilitating the process of IBD" (Estézes. 2016 |see Figure 4, left).
Figure 4: LEFT - Pathogenesis of dietary protein oxidation products in the GIT: transfer of oxidative stress from lumen to intestinal mucosa, tissue injury and inflammatory disease.f, RIGHT - Absorption and subsequent pathological effects of dietary protein oxidation products in targeted tissues (Estévez. 2016).
The molecular mechanisms of this pathological effect involved is, according to the authors of this most recent review a NADPH oxidase-mediated ROS generation, JNK phosphorylation, and poly (ADP-ribose) polymerase-1 (PARP-1) activation. Consequences of which studies show that their effects are not limited to the gut.
Protein oxidation during refrigerated storage of liver pâtés with added BHT sage or rosemary essential oils (p < 0.05, between antioxidant groups within a day of storage denoted by letters | Estévez. 2006)
Vitamin E doesn't work, vitamin C only increases the formation of PROTOX! Studies suggest that adding known anti-oxidant to your foods may both promote and inhibit the formation of PROTOX or Pox, as they are also called. The usual suspects, such as tocopherols, however, will be failing you, here. Some phenolic-rich plant and fruit extracts have been shown to exert anti-oxidative protection of proteins in cooked pork patties, porcine liver pâté (see figure on the left) and chicken, but the pro-/anti-oxidative effect depends on the structure and the concentration of the respective phenolic compound.

In beef patties, a rosemary extract was found to have no protective effect against Pox and a mixture of ascorbate and citrate promoted Pox, while both anti-oxidant systems protected lipids from oxidation. Furthermore, addition of rosemary oil to frankfurters has been shown to inhibit Pox while addition of higher levels of the rosemary oil resulted in a prooxidative effect when the frankfurters were prepared with meat from white pigs showing that the anti-oxidative effect was dependent on concentration and product characteristics. Lastly, it should be mentioned that the synthetic hydrophilic anti-oxidant Trolox (a vitamin E analogue) was found to prevent oxidation of both protein and lipid fractions (Lund. 2011).
As such, diets rich in readily oxidized components (polyunsaturared fatty acids) and meat proteins are believed have long been linked to a increased risk of suffering various forms of IBD such as Crohn's disease and ulcerative colitis (Hou et al., 2011), but it is also, as Estévez and Luna point out, also reasonable to hypothesize that such diets may contribute considerable oxidized proteins given the close association between LOX and PROTOX in food systems and in the gastrointestinal tract (Soladoye et al., 2015; Van-Hecke et al., 2015).
"Gurer-Orhan et al. (2006) already hypothesized that oxidized amino acids may be misincorporated into proteins such as enzymes and structural element in cells, potentially contributing to malfunction, cell apoptosis and disease. These authors emphasized that post-translational oxidative modification of proteins may not be the only factor that contributes to in vivo PROTOX suggesting that external (dietary) sources of oxidized amino acids may cause direct toxic effects by being used for de novo synthesis of proteins. To similar conclusions came succeeding studies carried out by Dunlop et al. (2008; 2011). The absorption and subsequent deleterious effects of unnatural oxidized amino acids such as meta-tyrosine and 3,4-dihydroxyphenylalanine (L-DOPA) are known to occur in animals and humans leading to dysfunctional proteins and toxicity (Dunlop et al., 2015). These species may not only be formed in foods as a result of tyrosine oxidation, they are also natural components of edible plants and beans (Siddhuraju & Becker, 2001; Davies, 2003; Dunlop et al., 2015). Chan et al. (2012) demonstrated that substitution of L-tyrosine residues in proteins with L-DOPA causes protein misfolding, promotes protein aggregation and stimulates the formation of autophagic vacuoles in SH-SY5Y neuroblastoma cells. Other oxidized forms of tyrosine, such as the ortho-tyrosine, contribute to the impairment of the insulin-induced arterial relaxation through the attenuation of endothelial nitric oxide synthase (eNOS) phosphorylation (Szijártó et al., 2014)" (Estévez. 2016).
Similar effects as they are described for oxidized tyrosine have been observed for oxidized tryptophan and lysine, which are present in significant amount in a plethora of processed foods including, but not restricted to meat and dairy.
Table 1: Relation of 2-AAA (oxidized lysine) levels to the risk of future diabetes in the whole sample and subgroups of 188 individuals who developed diabetes and 188 propensity-matched controls from 2,422 normoglycemic participants followed for 12 years in the Framingham Heart Study (Wang. 2013).
With respect to the latter, i.e. oxidized lysine, it is certainly worth poining out that 12-years long metabolomic study with human patients found this compound to be the most reliable indicator of diabetes risk - plus: Wang et al. were able to demonstrate that its oral ingestion increased the levels of the oxidized amino acid particularly in the pancreas, the same organ that is failing in diabetes (Wang et al., 2013). Other oxidized amino acids have been linked to
  • cell death in the intestine, colon and small intestine and subsequent irritable bowel disease (various) AOPPs; Xie et al (2014), Fang et al. (2012), Keshavarzian et al. (2003), Wu et al. (2015)
  • intestinal flora & redox state disturbance and liver & kidney stress, oxidized casein; Fang et al. (2012), Li et al. (2013), and Li et al. (2014)
With oxidized proteins and amino acids, there's thus yet another, often overlooked parameter of our food intake and dietary habits with "straightforward impact on health status" (Estevéz. 2016).
Bottom line: As premature as our understanding of the biology that governs the beneficial/detrimental effects of certain dietary components still is, there is ample evidence that not just the consumption of oxidized dietary fats, but also that of proteins, the major components of most foods (particularly animal-source), could harm us.

Fresh (!) Red Meat Acquitted - Overgeneralized Accusations that Red Meat Consumption Triggers Cancer Overlooks Influence of Processing & Other Confounding Factors | more
This does not mean that proteins (animal or plant proteins) are still a vital part of a healthy diet - that's indisputable. As Estevez and Luna point, out, "the discussion about dietary proteins [wich] is typically centered in the quantity, quality (≈ amino acid profile; biological value) and bioavailability upon digestibility," future recommendations for protein intake will have to consider the differential impact of foods with different PROTOX levels, as well. In this context, it should be obvious why "the current increase of the intake by population of highly processed animal-based foods with high protein content and presumably high oxidation rates" has been found to predict the raise of health disorders already associated to in vivo or dietary oxidative stress, in dozens if not hundreds of epidemiological studies | Comment!
References:
  • Awada, Manar, et al. "Dietary oxidized n-3 PUFA induce oxidative stress and inflammation: role of intestinal absorption of 4-HHE and reactivity in intestinal cells." Journal of lipid research 53.10 (2012): 2069-2080.
  • Bao, Yulong, and Per Ertbjerg. "Relationship between oxygen concentration, shear force and protein oxidation in modified atmosphere packaged pork." Meat science 110 (2015): 174-179.
  • Berlett, Barbara S., and Earl R. Stadtman. "Protein oxidation in aging, disease, and oxidative stress." Journal of Biological Chemistry 272.33 (1997): 20313-20316.
  • Chan, Sandra W., et al. "L-DOPA is incorporated into brain proteins of patients treated for Parkinson's disease, inducing toxicity in human neuroblastoma cells in vitro." Experimental neurology 238.1 (2012): 29-37.
  • Chang, Dong, et al. "Evaluation of oxidative stress in colorectal cancer patients." Biomedical and Environmental Sciences 21.4 (2008): 286-289.
  • Davies, Michael J. "Singlet oxygen-mediated damage to proteins and its consequences." Biochemical and biophysical research communications 305.3 (2003): 761-770.
  • Davies, Michael J. "The oxidative environment and protein damage." Biochimica et Biophysica Acta (BBA)-Proteins and Proteomics 1703.2 (2005): 93-109.
  • Dunlop, Rachael A., Roger T. Dean, and Kenneth J. Rodgers. "The impact of specific oxidized amino acids on protein turnover in J774 cells." Biochemical Journal 410.1 (2008): 131-140.
  • Dunlop, Rachael A., Ulf T. Brunk, and Kenneth J. Rodgers. "Proteins containing oxidized amino acids induce apoptosis in human monocytes." Biochemical Journal 435.1 (2011): 207-216.
  • Estévez, Mario, Sonia Ventanas, and Ramón Cava. "Effect of natural and synthetic antioxidants on protein oxidation and colour and texture changes in refrigerated stored porcine liver pâté." Meat science 74.2 (2006): 396-403.
  • Estévez, M. "Oxidative damage to poultry: from farm to fork." Poultry science 94.6 (2015): 1368-1378.
  • Estévez, M., and C. Luna. "Dietary Protein Oxidation: A Silent Threat to Human Health?." Critical Reviews in Food Science and Nutrition just-accepted (2016): 00-00.
  • Esterbauer, Hermann, et al. "The role of lipid peroxidation and antioxidants in oxidative modification of LDL." Free Radical Biology and Medicine 13.4 (1992): 341-390.
  • Esterbauer, Hermann. "Cytotoxicity and genotoxicity of lipid-oxidation products." The American journal of clinical nutrition 57.5 (1993): 779S-785S.
  • Fang, W., et al. "Effect of oxidated food protein on mice gut floraand redox state." Chinese Journal of Microecology 24 (2012): 193-196.
  • Gurer-Orhan, Hande, et al. "Misincorporation of free m-tyrosine into cellular proteins: a potential cytotoxic mechanism for oxidized amino acids." Biochemical Journal 395.2 (2006): 277-284.
  • Hou, Jason K., Bincy Abraham, and Hashem El-Serag. "Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature." The American journal of gastroenterology 106.4 (2011): 563-573.
  • Keshavarzian, A., et al. "Role of reactive oxygen metabolites in experimental colitis." Gut 31.7 (1990): 786-790.
  • Keshavarzian, A., et al. "Increases in free radicals and cytoskeletal protein oxidation and nitration in the colon of patients with inflammatory bowel disease." Gut 52.5 (2003): 720-728.
  • Li, Zhuqing Leslie, et al. "Effect of oxidized casein on the oxidative damage of blood and digestive organs in mice." Acta Nutrimenta Sinica 35.1 (2013): 39-43.
  • Li, Zhuqing Leslie, et al. "Oxidized casein impairs antioxidant defense system and induces hepatic and renal injury in mice." Food and Chemical Toxicology 64 (2014): 86-93.
  • Li, Zhuqing Leslie, et al. "24-Week Exposure to Oxidized Tyrosine Induces Hepatic Fibrosis Involving Activation of the MAPK/TGF-β1 Signaling Pathway in Sprague-Dawley Rats Model." Oxidative medicine and cellular longevity 2016 (2015).
  • Lund, Marianne N., et al. "Protein oxidation in muscle foods: A review." Molecular nutrition & food research 55.1 (2011): 83-95.
  • Sante-Lhoutellier, Veronique, Laurent Aubry, and Philippe Gatellier. "Effect of oxidation on in vitro digestibility of skeletal muscle myofibrillar proteins." Journal of Agricultural and Food Chemistry 55.13 (2007): 5343-5348.
  • Siddhuraju, Perumal, and Klaus Becker. "Rapid reversed-phase high performance liquid chromatographic method for the quantification of L-Dopa (L-3, 4-dihydroxyphenylalanine), non-methylated and methylated tetrahydroisoquinoline compounds from Mucuna beans." Food chemistry 72.3 (2001): 389-394.
  • Sies, Helmut, Wilhelm Stahl, and Alex Sevanian. "Nutritional, dietary and postprandial oxidative stress." The Journal of nutrition 135.5 (2005): 969-972.
  • Soladoye, O. P., et al. "Protein oxidation in processed meat: Mechanisms and potential implications on human health." Comprehensive Reviews in Food Science and Food Safety 14.2 (2015): 106-122.
  • Stadtman, Earl R. "Metal ion-catalyzed oxidation of proteins: biochemical mechanism and biological consequences." Free Radical Biology and Medicine 9.4 (1990): 315-325.
  • Stadtman, E. R. "Oxidation of free amino acids and amino acid residues in proteins by radiolysis and by metal-catalyzed reactions." Annual review of biochemistry 62.1 (1993): 797-821.
  • Szijártó, Andras István, et al. "Elevated vascular level of ortho-tyrosine contributes to the impairment of insulin-induced arterial relaxation." (2014).
  • Villaverde, Adriana, and Mario Estévez. "Carbonylation of myofibrillar proteins through the Maillard pathway: Effect of reducing sugars and reaction temperature." Journal of agricultural and food chemistry 61.12 (2013): 3140-3147.
  • Wang, Thomas J., et al. "2-Aminoadipic acid is a biomarker for diabetes risk." The Journal of clinical investigation 123.10 (2013): 4309-4317.
  • Wu, Peiqun, et al. "Advanced oxidation protein products decrease the expression of calcium transport channels in small intestinal epithelium via the p44/42 MAPK signaling pathway." European journal of cell biology 94.5 (2015): 190-203.
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Jumat, 06 Mei 2016

The Insulin / Glucagon Ratio and Why Diabetics and People W/ Severe Insulin Resistance Must be Careful With Protein

You're insulin resistant and trying to lose weight with high protein intakes? Then you got to read this article carefully...
High protein diets can help you lose weight while maintaining muscle mass. This should make them the ideal choice of diabetic patients, many of whom are suffering from weight issues that are often not corollary, but rather causatively involved in the development of type II diabetes.

Unfortunately, studies in type I diabetics and preliminary evidence from type II diabetics and other insulin resistant individuals suggests that - if the disease has progressed significantly - eating too much protein can be a problem, as well, one that may worsen the ill effects of diabetes.
Having high amounts of protein after fasting may ruin your glucose levels?!

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The reason for the potentially detrimental effects of high protein intakes on glycemia is well-known, but rarely acknowledge: gluconeogensis. As early as in the 1970s, researchers observed that the administration of a high-protein diets to rats, can significantly elevate plasma glucose and insulin concentrations and reduce the sensitivity of fat cells to insulin (Blazquez. 1970).
Figure 1: Post-prandial insulin and glucose levels in rats after several weeks of high protein feeding (Blazquez. 1970).
Over the decades after the publication of the Blazquez study, evidence for both the beneficial (Tremblay. 2007) and potential ill effects (Unger. 1971; Eisenstein. 1974) of high protein diets on diabetes and insulin resistance has been accumulating (Linn. 2000).
Sign. increases in urea prod. are another consequence of protein-based gluconeogenesis (Gannon. 2001).
As usual you will find conflicting evidence: In 2001, for example, Gannon et al. found only a modest increase in serum glucose levels in type II diabetics in response to the ingestion of 50g of protein - in spite of the fact that ~20-23g of it were converted to glucose in the liver.

What is important to note, however, is the fact that the protein source in the Gannon study was lean beef - one of the slowest sources of protein you can have and thus not exactly the #1 candidate for being subjects to immediate and thus glucose raising gluconeogenesis.
In that, it has been know for almost as long that the degree of offset of the ratio of glucagon to insulin in type I and II diabetics may decide, whether the ingestion of high(er) protein diets will help or hinder glucose management. In the pertinent, seminal review, Unger observes that "the insulin:glucagon ratio (I/G) varies inversely with need for endogenous glucose production, being lowest in total starvation and highest during loading with exogenous carbohydrate" (Unger. 1971). It is thus not surprising that studies have observed that
  • the infusion of the glucose precursor, alanine, in the fasting state causes a fall in I/G, a “catabolic response,” but increases I/G during a glucose infusion, an ”anabolic response, which spares alanine from the fate of being abused for gluconeogenesis, 
  • similar effects have been observed after a protein load; normally after an overnight fast I/G rises in response to a beef meal, an anabolic response, while in the carbohydrate-deprived subject, the I/G does not rise, remaining at a catabolic level (cf. Chevalier. 2006)
Now, back in the day these observations were mainly used to support the concept of a "protein sparing action" of glucose. Today, the effect on gluconeogenesis, i.e. the production of glucose from proteins / amino acids in the liver, has moved to the center of attention of a number of scientists. Calbet and MacLean, for example, investigated how the plasma glucagon and insulin responses of humans would depend on the rate of appearance of amino acids after ingestion of very fast vs. fast protein sources.
Figure 2: Glucose and glucagon levels in the blood of healthy volunteers after ingesting either 25g glucose or protein solutions containing whey protein hydrolysate (WPH), pea peptide hydrolysate (PPH) or milk protein (MS | Calbet. 2002).
Their results (see Figure 2) indicate the obvious: Even in healthy individuals and even upon co-administering protein sparing and 25 g of anti-gluconeogenic glucose, the fastest protein sources (whey protein, WPI; pea peptide hydrolysate; PPH) produce the highest increase in glucagon, gluconeogenesis and thus serum glucose levels in the first 20 minutes after the ingestion of the 25 g of glucose plus ~30g of the different proteins.
Let's just be clear here: I am not saying that high protein diets cannot help with diabetes. I am just saying that bolus intakes of protein can be problematic for type I diabetics and people with severe insulin resistance and progressive type II diabetes.
What may not be a major problem for healthy individuals, though, can be a deal-breaker for diabetics, in whom studies into the inter-organ flux of substrates after a protein-rich meal (slow digesting beef 3g/kg body weight) show that the normally non-significant effect on glycemia (<5% in healthy subjects) was exuberant in the diabetic subjects in whom you will see a greater rise in blood glucose, and a three-to-fourfold increment in splanchnic glucose output at 30-90 min that was triggered by a doubling of arterial glucagon, which was not compensated for by an concomitant increase in insulin as it occurred in the healthy test subjects (Wahren. 1976).
Figure 3: Rel. changes in blood glucose after ingestion of 3g/kg lean meat in healthy and diabetic subjects (Wahren. 1976).
Whether an increase in protein intake will have beneficial or ill effects on your ability to control your glucose levels will thus clearly depend on the degree of hepatic insulin resistance / pancreatic dysfunction you expose.
  • If you are severely diabetic and/or insulin resistance, i.e. you either don't produce enough or no insulin in response to the ingestion of protein or your body does not react to the insulin, as it would be the case in type I diabetes and progressive type II diabetes, your glycemia may be impaired by high protein meals.
  • If you are only slightly insulin resistant, you will probably benefit from the insulinogenic effects of protein and the ability to replace carbohydrates in your meals with protein. You may nevertheless want to test your individual glucose response to fast-digesting proteins like whey or amino acid supplements, which may still result in an uncontrolled gluconeogenic response.
  • If you are healthy and insulin sensitive, you won't have to worry about the gluconeogenic effects of high protein intakes - regardless of whether we are talking about fast or slow protein sources, because the former will spike insulin enough to blunt any pro-gluconeogenic effects of the concomitant increase in glucagon to keep the rates of gluconeogenesis and thus your glucose levels in check.
So, just as you've read it here at the SuppVersity before, what's good and what's bad for your cannot be generalized - even when it comes to something as popular as increasing your protein intake.
What do you have to remember? High protein intakes, especially in form of large bolus intakes of 30g or more protein per session can trigger unwanted glucose excursions. These problems with glucose management occur almost exclusively in diabetics, in whom the protein-induced increase in insulin and / or the effects of this increase in insulin is / are blunted.

Figure 1: GIP and GLP-1 response to whey and white bread (left, top & bottom); insulin release (%) per islet relative to glucose after incubation with different amino acids, amino acid mixtures and mixture + GIP (Salehi. 2012) | more
Due to the unavoidable protein induced increase in glucagon, diabetics and people with severe insulin resistance will fall into a catabolic state in which the lions share of the protein they ingest will be subject to gluconeogenesis, i.e. the production of glucose from proteins / their amino acids in the liver. The consequence of the skyrocketing rates of gluco-neogenesis is an increase in blood glucose that will only exacerbate the existing damaging effects of elevated glucose levels in diabetics and people with severe insulin resistance. Since the of gluco-neogenesis depends on the rate of appearance of amino acids in the blood, fast-digesting proteins like whey are more prone to trigger this effect than slow-digesting proteins like meat.

If you don't belong to the previously referred to group of people suffering from type I or severe type II diabetes and/or severe insulin resistance, though, you don't have to worry that high(er) protein diets could mess with your ability to manage your glucose levels | Comment on Facebook!
References:
  • Blazquez, E., and C. Lopez Quijada. "The effect of a high-protein diet on plasma glucose concentration, insulin sensitivity and plasma insulin in rats." Journal of Endocrinology 46.4 (1970): 445-451.
  • Calbet, Jose AL, and Dave A. MacLean. "Plasma glucagon and insulin responses depend on the rate of appearance of amino acids after ingestion of different protein solutions in humans." The Journal of nutrition 132.8 (2002): 2174-2182.
  • Chevalier, Stéphanie, et al. "The greater contribution of gluconeogenesis to glucose production in obesity is related to increased whole-body protein catabolism." Diabetes 55.3 (2006): 675-681.
  • Eisenstein, Albert B., Inge Strack, and Alton Steiner. "Glucagon stimulation of hepatic gluconeogenesis in rats fed a high-protein, carbohydrate-free diet." Metabolism 23.1 (1974): 15-23.
  • Gannon, M. C., et al. "Effect of Protein Ingestion on the Glucose Appearance Rate in People with Type 2 Diabetes 1." The Journal of Clinical Endocrinology & Metabolism 86.3 (2001): 1040-1047.
  • Linn, T., et al. "Effect of long-term dietary protein intake on glucose metabolism in humans." Diabetologia 43.10 (2000): 1257-1265.
  • Tremblay, Frédéric, et al. "Role of dietary proteins and amino acids in the pathogenesis of insulin resistance." Annu. Rev. Nutr. 27 (2007): 293-310.
  • Unger, Roger H. "Glucagon and the insulin: glucagon ratio in diabetes and other catabolic illnesses." Diabetes 20.12 (1971): 834-838.
  • Wahren, J., P. H. I. P. Felig, and L. A. R. S. Hagenfeldt. "Effect of protein ingestion on splanchnic and leg metabolism in normal man and in patients with diabetes mellitus." Journal of Clinical Investigation 57.4 (1976): 987.