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White Paper: Protein: Its Significance in Sports and Geriatric Nutrition

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White Paper: Protein: Its Significance in Sports and Geriatric Nutrition White Paper: Protein: Its Significance in Sports and Geriatric Nutrition - Unique plant-based proteins are seeing high demand, with branched-chain amino acids receiving major marketing exposure Introduction Protein is one of the most important macronutrients in our diet. The essential nutrient is a component of every cell in the body and is vital to its overall health (Pederson and Cederholm, 2014). Many different types of proteins exist in our body, making up important building blocks of bones, muscles, cartilage, skin, hair and blood. Excluding water, protein makes up 75% of body weight. All protein is composed of 20 amino acids. Depending on the protein type, these amino acids are held together at the molecular level by different bonds. Of the 20 amino acids, only 10 are considered "essential" to obtain from the diet (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine), as these cannot be synthesized by the body, and are very important, as the body utilizes these amino acids to manufacture the other 10 "non-essential" amino acids. It is important to note that while arginine is not an essential amino acid, as it can be manufactured in the body of adults from other amino acids, supplementing the body with higher levels of this amino acid can produce muscle-preserving effects and increase blood flow, as a nitric oxide precursor, as described later. Regardless of its source, all proteins, either from animal or plant, are composed of the same amino acids, but the ratio of these amino acids is typically quite different. Most plant proteins, unlike animal- and dairy-derived proteins, are not generally considered "complete" proteins, as these may lack adequate levels of one or more of the essential amino acids, such as methionine, tryptophan or lysine. Soy protein is an exception, because it has all necessary essential amino acids to be considered complete. The amino acids lacking in certain plant proteins, or "limiting" amino acids, differ by plant protein source. In order to use plant proteins as "complete protein systems", other than soy protein, the protein industry typically selects different plant proteins to equalize the amino acid profiles of plant- protein products with those from animal origin. A popular combination is pea protein blended with brown rice or oat protein(s). For example, brown rice protein is high in methionine and tryptophan but typically lacks adequate lysine levels to be classified as a complete protein source by itself, while pea protein is the other way around. As a consequence of certain limiting amino acids, vegetarians and vegans need to consume a variety of plant protein sources in their diet or a unique blend of plant proteins, such as those in ProNexTM plant protein blend (see below for more information), to meet their complete protein requirements. Protein and Human Health Protein is a very important dietary component, influencing the metabolism in many aspects of human health ((Elmadfa and Meyer, 2017; Pederson and Cederholm, 2014; Wu, 2016). Our body breaks down dietary protein into its individual amino acids that it then uses to maintain proper day-to-day bodily functions, provide growth and repair tissues. For example, protein is used to create enzymes that are required to perform specific chemical reactions in the body, like helping to break down food components, such as carbohydrates, fats and proteins so they may be used by the body. Protein is also used to make antibodies for disease resistance, hormones that are used as metabolic signaling agents to coordinate various bodily functions, and collagen, a structural component of skin, bones and tendons. Proteins also help facilitate transport and storage of various hormones, medicines and enzymes throughout the body. Science has proven that these functions increase lean body mass, maintain current muscle tissue size and help strengthen bones. Protein also does not induce fat storage and it aids glycemic control. Because of these attributes, protein is an effective component in weight loss plans, helping to normalize blood sugar and induce satiety (suppresses hunger), while providing necessary amino acids that act as building blocks that promote muscle recovery following exercise; an important consideration for athletes and exercise enthusiasts. However, unlike the body's ability to store fats and carbohydrates, the human body does not possess the ability to store protein; it has no reservoir to draw at times of need. So, it is important to consume enough dietary protein daily, but the sufficient quantity depends largely on age, gender, health, and on the level of physical activity. Typically, the majority of people in Western society get adequate protein levels in their diet, but in certain cases, such as those that partake in intense physical activity (athletes) and aging adults (geriatrics), higher protein intake is necessary. Protein intake recommendations for normal healthy adults, training athletes and aging adults The Daily Reference Intake (DRI) value of protein for healthy adults as established by the U.S. Institute of Medicine (IOM) is 0.8 g of protein/kg of body weight (0.36 g/lb) per day (IOM, 2005). However, a recent 2016 joint position paper on nutrition and athletic performance, the American College of Sports Medicine (ACSM), the Academy of Nutrition and Dietetics (AND), and Dietitians of Canada recommended that higher protein intakes are necessary for athletes, and athletes should also consider the timing of the protein intake (Thomas et al., 2016). The joint paper on nutrition and athletic performance made no distinction between strength and endurance athletes, citing that dietary protein intake necessary to support metabolic adaptation, repair, remodeling, and for protein turnover typically ranges from 1.2 to 2.0 g/kg (0.5 to 0.9 g/lb) of body weight per day. Furthermore, they recommend that daily protein needs should be met using an intake plan that spreads the total daily amount of high-quality protein across the day and following strenuous training sessions. The joint commission also noted that muscle protein synthesis is maximized by consuming 0.3 g protein/kg body weight every three to five hours, including consuming this amount within two hours post-exercise. A more recent systematic review, meta-analysis and meta-regression performed in 2018 on the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults found that consuming 1.6 g/kg (0.73 g protein/ lb) of body weight per day was the most effective dose for building muscle, and also determined that timing of protein intake was not important for gains in muscle mass and strength (Morton et al., 2018). The study published in the British Journal of Sports Medicine determined that as long as daily protein intake of 1.6 g/kg body weight per day was separated into 0.25 g/kg body weight doses, the total amount was sufficient for muscle protein synthesis. In addition to specific recommendations for performance athletes, current studies from the PROT-AGE Study Group (2013) also suggest that most individuals over age 65 should consume about 1 g to 1.2 g of protein/kg of body weight (0.45 to 0.55 g/lb) per day to both gain and maintain muscle mass and function (Bauer et al., 2013), as age-related muscle loss, known as sarcopenia, ranges from 0.5% to 2% of total muscle mass each year after the age 50 (Buford et al., 2010; Mitchell et al., 2012; Nair, 2005). Studies have suggested that starting in our late 20s and early 30s, individuals begin to lose muscle mass, with physically inactive people losing as much as 3% to 5% per decade after age 30 (McLeod et al., 2016; Mitchell et al., 2012; Sinnige et al., 2013). The rate of sarcopenia typically takes a significant increase around age 75, but may also increase as early as 65 or as late as 80, becoming a major factor in frailty and increased potential for falls and fractures in older adults (Santilli et al., 2014; Shafiee et al., 2017; Walston, 2012). There is currently no separate recommendations for people between the ages 50 and 65, but it is safe to say that getting enough protein during that time is sound nutrition sense (Nowson and O'Connell, 2015), as by age 65, both exercise and high-quality protein intake are necessary , as older adults are less efficient in using amino acids from protein for muscle protein synthesis than are young adults, a phenomenon known as "anabolic resistance" (Cuthbertson et al., 2005; Drummond et al., 2008; Chul Jang, 2016; Shad et al., 2016). The definition of what constitutes high-quality protein will be defined under the protein quality assessments and branch-chain amino acid sections). Studies clearly show that equal amounts of protein do not stimulate muscle protein synthesis (growth) the same in older versus younger adults (Drummond et al., 2008; Cuthbertson et al., 2005). Older adults require much more muscle stimulation than their young counterparts to initiate muscle growth, an effect that may be related to reduced blood flow to muscle tissue (Burd et al., 2013). Older adults have also been shown to experience decreased appetite with aging (Malafarina et al., 2013; Pilgrim, 2015), possibly from denture use or chewing difficulties (Lee et al., 2006), constipation issues (Soldmdal et al., 2012), or use of certain medications that reduce appetite or alter sense of taste or smell (Qato et al., 2008; Schiffman, 1997), thus making it more difficult to maintain proper caloric and protein intake. In a recent study performed in 2015 by Kim and colleagues at the Center for Translational Research in Aging and Longevity at Little Rock, AK, adults over the age of 50 who approximately doubled the DRI of protein, consuming 1.5 g/kg (0.68 g/lb) body weight, were better able to rebuild and retain muscle after only four days, when compared with a healthy control group consuming only the DRI recommended level of 0.8 g/kg body weight.
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