Too soon to say, but favorable

thus far: a review of protein and

body composition
Jacob Seymour | June 17, 2015
INTRODUCTION
As part of the Protein Summit 2.0, a study was published in the June 2015 issue of the American
Journal of Clinical Nutrition by Leidy et al. entitled The role of protein in weight loss and
maintenance. The goal of the systematic review was to summarize the existing body of research
looking at increased protein in the diet as a means to lose weight and keep it off. In the words of
the author, The purpose of this article is to provide an overview of the literature that explores
the mechanisms of action after acute protein consumption and the clinical health outcomes after
long-term, higher-protein diets. Also investigated was the acceptability and compliance to the
chronic consumption of increased dietary protein, followed by an issuing of novel
recommendations for protein quantity and timing of consumption to achieve improvements in
weight management. They conclude, higher-protein diets that contain between 1.2 and 1.6 g
protein kg1 d1 and potentially include meal-specific protein quantities of at least 2530 g
protein/meal provide improvements in appetite, body weight management, and/or
cardiometabolic risk factors compared with lower-protein diets. Assuming adherence to the diet,
which studies bear ought to be difficult, there is greater satiety, weight loss, fat mass loss,
and/or the preservation of lean mass [] observed with increased protein consumption.
There are myriad strengths and weaknesses in this report. Most weaknesses are a result not of the
systematic review itself, but the weaknesses of the studies which the study in question
systematically reviews. The purpose of this paper is to discuss the validity of the conclusion that
was reached and the data used to reach it.
STRENGTHS
First, the data used was from a diversity of studies on the topic of protein consumption. Included
were meta-analyses, randomized cross-over studies, case control studies, and animal studies. By
reviewing all the data available, a more complete picture of the benefits of protein consumption
as it is now understood was provided. Once amassed, the data made a decent case for increased
protein intake as a means to achieve weight loss and sustain it.
Second, high-protein diets were portrayed successfully as an effective means to a highly desired
end. A perusal of the paper doesnt suggest many major vacancies in the data that would make it
inappropriate to consider the idea of increased protein consumption as a potential method of
facilitating weight loss and maintenance. When there were vacancies, however, the authors
almost always called attention to them.

Third, the final strength of the study was its unreserved transparency in disclosing the limitations
of the current body of knowledge and also making clear the necessity of further investigation.
They used phrases such as, further strategies [] are waranted, whether the time course []
was adequate [] is unclear, the data are inconclusive, more work is needed, there are no
[studies] to date, it is difficult to determine the actual contribution, future [] research is
needed[/warranted], this concept is worth exploring, lack of dietary compliance [] makes
it challenging, and even dedicated a table at the end of the paper to the Limitations and/or gaps
in the current literature, as is pictured above.
WEAKNESSES
One important misconception made early in the study was the recentness of the utility of highprotein diets. Over the past 20 y, higher-protein diets have been touted as a successful
strategy In reality, high-protein diets are not as recent as they describe. They are sometimes
regarded as new because they are quickly written off in the mainstream before they can take root
due to their perceived ability to make ones diet imbalanced, especially in the eyes of pro-

government dietary guideline authorities. Two popular examples of classic high-protein diets
include The Banting Diet and the Atkins Diet. William Banting, born in 1797, recognized the
power of high-protein diets in treating obesity and overweight many decades prior to the late
Robert Atkins, who served to popularize the idea of a high-protein diet. Robert Atkins got the
idea for his diet from a paper published in 1958 by Alfred Pennington. In both cases, highprotein diets have been used for centuries. Modern hunter-gatherers also consume high-protein
diets when possible and suffer excellent body compositions as a consequence. There is some
evidence for high-protein diets being the main diet consumed by human ancestors. That said, one
should not focus on protein exclusively.
Few creatures, if any, consume purely protein. It is a fact that humans cannot survive on protein
alone. Protein is merely a component of a whole foods, natural diet. From this perspective, this
paper and the others that focus just on protein are reductionist. While one may argue that it is
important from a scientific stand point to isolate variables, one should only reduce to the lowest
common denominator. In nutrition, assuming whole food nutrition to be optimal, this
denominator is not protein, for very few foods exist that are purely protein. The human diet is a
combination of macronutrients, which includes protein, and deserves to be investigated as such,
especially because of the significant interactions between the macronutrients. For example, most
sources of high-quality protein in nature also include fat. But since fat has satiating properties
and effects on gastric emptying, simply looking at the defatted sources of protein will not play
out in the real world where people eat fat with their protein, or at least would, if they followed a
whole foods diet.
To reduce the diet down to a single macronutrient doesnt give the diet justice. For when you
increase protein, there are compensatory results to each of the other macronutrients. Therefore,
whenever any study is used to reach a conclusion about protein, it could be, in reality, also
making a case for high-carbohydrate, high-protein, low-fat or any combination therein as along
as protein is high. A diet is best identified when each of the three macronutrients are described in
relative proportions to each other and whether the diet is restricted, ad libitum, or forcefully
excessive. By looking only at protein, there may now be a misattribution of the mechanism of
action. Included in the study was commentary on very low-carbohydrate ketogenic diets. This
leads one to believe that a high-protein diet is equivalent to a ketogenic diet. But this is far from
the case, as any adherent and medical professional who implements a VLCKD in their practice
would staunchly maintain. For very good reasons a VLCKD is a low-carbohydrate, moderateprotein, and high-fat diet. Protein is not unlimited in these diets due to the likelihood of
gluconeogenesis. Once again, reducing the diet to a single macronutrient is reductionist, and,
frankly, too much of a word game to let go unchecked. Protein should be investigated as a
component, and especially not as an energy source.
Approaching protein from an energetics mindset is not productive for protein is a poor source of
energy. Its main physiological role is structural. The body doesnt work in terms of calories,
especially in the case of protein. When it needs protein, it needs a mass quantity of structural
components to rebuild and maintain the integrity of the body. Because this mass quantity varies
in response to an unlimited list of factors including stress, activity level, growth factors, immune
system activity, and enzyme production, thinking of protein in terms of its calories is a

misguided effort. To date no study has intended to quantify as accurate as possible protein
necessity based on a litany of day-to-day factors. While there are current generalizations, such as
pregnant women, the elderly, and those who weight train needing more protein, a reliable
measure has not been formulated. A high-protein diet in this sense would exceed the amount of
protein needed to maintain all processes of the body. Yet, most studies arbitrarily assign a highprotein meal to be on the order of 30 grams of protein. However, depending on infinite variables
30 grams of protein could be a low-normal amount of protein were the individual, unbeknownst
to them, fighting a quiet infection, for example. The protein needs constantly in flux need to be
quantified as best as possible. Once quantified, these needs, as they currently tend to be, are best
met via animal protein.
Plants are not reliable sources of protein and do not form the major protein composition of the
American diet. Therefore studies using plant protein to investigate the potential weight loss
properties of animal protein, the best source and predominant source of protein for Americans, is
fundamentally flawed. Therefore studies using plant protein should not be used to form the basis
of the papers argument, though it was. Fortunately, the studies that used plant protein are limited
and probably dont hold much weight in the verdict the authors propose. This is speculation,
however, and is but a trivial example of the studys somewhat regularly occurring bouts of not
including enough detail.
Throughout, the study featured a lack of elaboration. Very little attention was given to the amino
acid composition of protein, which can make all the difference in terms of optimal health.
Specific amino acids, the building-blocks of proteins, can trigger different signals in the body.
For example, leucine is unique in that it can trigger the release of insulin, a known mediator of
food intake. Since very little was mentioned about amino acids, it is overall too early to attribute
the effects of satiety to protein as a unit. Case in point: many times vital considerations were not
included.
Occasionally, there was an occlusion of important details, such as the glycemic index. Last,
although the previous meta-analyses do not include the findings from the Diet, Obesity and
Genes (Diogenes) Study, it is the largest trial to date comparing lower- with higher-protein diets
for weight-loss maintenance and thus merits specific discussion Glycemic index was also
included within these diets but is not included in this discussion. Almost more tragically, no
discussion was given to the micronutrient density of the sources of protein.
The body is constantly in flux and does its best to maintain itself in a state of homeostatic
balance. Given the infinite wisdom of the human body, one cannot neglect, as this study did, the
role of micronutrient density in the protein source. Animal studies, which have the advantage of
using less crafty creatures than humans, demonstrate that when given an option between two
meals that differ only in nutrient density, not taste, energy density, water content, etc., the mice
will instinctively gravitate toward the more nutrient-dense mealthe one that prevents
deficiencies. This is a case for how humans came to consume nutrient dense foods and intuitively
perform cooking techniques, which increases nutrient bioavailability, even before they knew
what a nutrient was because it was the desire of their bodies to obtain optimal nutrition. The
study should have mentioned more about the sources of protein and accompanying nutrients, as

this could have an effect on satiety, food choice, and sustainability. Another detail that could
have used more elaboration than was mentioned was that of proteins physical state.
The study did an excellent job calling attention to the possibility of problems in comparing
protein of different physical states. However, these studies have a good reason not to be used in
reaching a conclusion: almost all natural protein sources are solids. Liquid protein sources
generally are predigested. Therefore they bypass the initial steps of digestion and rapidly begin to
enter the blood stream. Just as a high-glycemic meal can produce different hormonal outcomes,
an isolated, processed, reduced source of protein will as well. By reducing protein down to
protein, regardless of its state, they missed a crucial point. Likewise, when they reduced hunger
down to just a serum level of chemical messengers, they missed another point.
Ultimately, what matters is weight loss and maintenance and the ability for people to sustain and
enjoy their diet. Measuring hunger and appetite hormones as surrogates for these states are
not reliable in terms of assessing long-term feasibility or compliance unless they correlate
precisely. And they dont. In this sense, the paper included studies that measured a faulty
outcome. More discussion should have been included.
Although not definitive, potential reasons for the increased acceptability may be due to the
satiating effects of protein and anticipated improvements in body weight management. These
reasons are given a single sentence of attention. In this sense, this study somewhat glances over
important questions or gaps in the research while extensively covering individual studies that
support their hypothesis. Much elaboration is needed on a point that follows: the lack of
adherence to higher-protein diets is typically attributed to behavioral and/or environmental
factors. What are these behavioral factors? What are these environmental factors? And why
arent these discussed extensively? One of the most alarming moments of silence was the
feasibility of following a high-protein version of the diet in accordance with current government
guidelines.
While the authors suggest that a high-protein diet can coincide with dietary guidelines, they dont
discuss in sufficient detail the potential points of conflict with the current government guidelines.
A whole foods diet is optimal for health. Whole food animal sources of protein are superior to
whole food plant sources of protein. Whole food animal sources of protein also tend to be animal
sources of fat, primarily saturated. Most whole food animal sources of fat are looked down upon
by those who promote the government guidelines as a means to be healthy. Therefore highprotein diets do not coincide well with the government guidelines unless if they are formulated to
meet one of two conditions: 1) the high-protein, low-saturated fat foods eaten are whole, and
healthy, but dont come in great variety (restricted to seafood and some organ meats), or, 2) the
foods must be processed, isolated, and separated (proteins removed from their natural packaging
or format and chemically purified). Surely a food stripped of its natural form is not how nature
intended humans to obtain nutrients. The study states, increased dietary protein, within the
context of very-low-carbohydrate and high-fat intakes, improves weight management, reduces
cardiometabolic risk factors, and might aid in the treatment of obesity and other disease states
over the long term. However true that may be, this doesnt coincide whatsoever with current
government guidelines and could not be made to under any condition. The current government

guidelines are a barrier to more effective nutrition science. Given the difficulty in obtaining
funding for studies that look at whats wrong with the diet promulgated by those who fund,
theres no surprise in the lack of elaboration and chronic understatements.
In reviewing the Acknowledgements section, one can easily note a severe risk for bias. To the
authors credit, it was acknowledged that the participants in the study had myriad vested
interests. They state, None of the sponsors were involved in the design, implementation,
analysis, or interpretation of data. Nevertheless, this still had great potential to make the
conclusion somewhat murky. HJL has current funding from The Beef Checkoff, Egg Nutrition
Center, and DuPont Nutrition & Health. She is also on the speakers bureau for the National
Cattlemens Beef Association. PMC has conducted protein-related research funded by Meal and
Livestock Australia and Dairy Australia and published a number of high-protein cookbooks. AA
is a consultant/member of advisory boards for the Dutch Beer Knowledge Institute, Global Dairy
Platform, Jenny Craig, McCain Foods Ltd, McDonalds, and the Gerson Lehrman Group (ad hoc
consultant for clients).
CONCLUSION
Given the nascency of the body of literature and thus lack of uniformity among studies, any
conclusion is a premature conclusion regarding high-protein diets. As it stands, this paper should
not be regarded as definitive, however, but is not to be viewed as unimportant. Before the
scientific community can be sure that a high-protein content results in desirable outcomes, more
refined studies are required looking at protein in its proper context of a whole foods diet.

Works Cited

Leidy, H. J., P. M. Clifton, A. Astrup, T. P. Wycherley, M. S. Westerterp-Plantenga, N. D.

Luscombe-Marsh, S. C. Woods, and R. D. Mattes. "The Role of Protein in Weight Loss
and Maintenance." American Journal of Clinical Nutrition 101.6 (2015): 1320S-29S. The
American Journal of Clinical Nutrition. American Society for Nutrition. Web. 10 June
2015.