April 9, 2026 • 50 mins
This week, Emily and Perry explore the vast array of protein vehicles that's taken over our influencer culture and supermarket aisles. How much protein are we told we need, and what's the over/under on how much we really need? What does protein do for our bodies anyway? And given the protein bars and protein water and protein Pop Tarts available (protein is having a moment, you guys), is it possible to have too much?
Plus: GLP-1s all over the news cycle, the rising use of gas station kratom, and, ladies and gentlemen, the American Contact Dermatitis Society presents our 2026 Allergen of the Year.
Submit a question for our weekly mailbag at wellnessactually.fm.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Hey, everybody, Just a quick correction from last week. At
the end of the episode. In the mailbag, we were
talking about colon cancer screening and I said that the
colon guard test is done yearly. That's not right, It's
done every three years. The fit testing, which is another
forum of stool based testing, is the yearly colon cancer
screening test. Thanks so much to amazing doctor Clay Ackerley
for pointing that out for us. Now onto the episode.
Speaker 2 (00:24):
Hi, Perry, high, Emily, nice to see you, you too?
Which has more protein?
Speaker 3 (00:30):
Cup of cottage cheese or a cup of Greek yogurt?
Speaker 1 (00:33):
Oh? Why are you doing this to me? I am
going to say a cup of cottage cheese with low confidence.
Speaker 3 (00:39):
Excellent, one score of one. Okay.
Speaker 2 (00:43):
Second question, high demand for what product led to weigh
protein being primarily the source of protein for protein shakes,
cheese generally cheese is the correct?
Speaker 1 (00:58):
Okay?
Speaker 3 (00:58):
Cancer?
Speaker 1 (00:59):
All right of two?
Speaker 3 (01:00):
Okay, very hard. Last question.
Speaker 2 (01:03):
There is a new protein product called a David protein bar.
It has a lot of protein. The company that makes
it introduced a second product to expand their line. What
is that second product?
Speaker 1 (01:16):
It's gotta be Goliath.
Speaker 3 (01:21):
No, And that's on the table. They left that on
the table.
Speaker 2 (01:25):
The new product is frozen cod Oh, and that's all
you need to know about protein.
Speaker 1 (01:33):
Wow. So, I, in anticipation of this episode, for the
first time really ever, tracked everything I put into my body,
everything I ate for a few days because I had
no idea how much protein I was taking it. And
I will tell you two things. Number One, I don't
like writing down everything that I eat. It's annoying, it's
(01:56):
hard to search for I don't know what portion sizes
are and it makes me feel guilty. And two, the
amount of protein I intake from day to day varies
wildly and depends almost entirely on whether my kids are
having pasta for dinner or not.
Speaker 3 (02:12):
What was your protein number?
Speaker 1 (02:14):
So the highest day I had was one hundred and
fifty grams and the lowest day I had was sixty grams.
Speaker 3 (02:21):
Wow, that is a lot of variation.
Speaker 2 (02:23):
Yeah, I eat exactly the same amount of protein every
single day.
Speaker 1 (02:28):
I think that may say everything anyone needs to know
about the two of us. Should we dig into this?
Speaker 3 (02:34):
We should.
Speaker 2 (02:38):
I'm Emily Aster, I'm an economist and a data expert.
Speaker 1 (02:41):
And I'm Perry Wilson. I'm a medical doctor.
Speaker 2 (02:44):
It's Thursday, April ninth, twenty twenty six, and this is wellness.
Speaker 1 (02:48):
Actually, because you're getting a staggering amount of health and
wellness information nowadays from every source imaginable, and some of
it is awesome.
Speaker 2 (02:57):
And some of it is well actually both Fortunately we
are both people who know how to read studies, how
to parse the data, and can tell you what's worth
thinking about and what you can safely ignore.
Speaker 1 (03:10):
But before we dig in, a note that this podcast
is for educational purposes and should not be construed as
medical advice. We don't know your unique situation, so talk
to your doctor for personal health decisions.
Speaker 3 (03:22):
This week we're asking what's the deal with protein?
Speaker 2 (03:25):
Perry and I will give the official smash her pass
and then we'll get to your question of the week.
But first let's do the health news roundup after the break.
And now for the health news of the week, Perry,
(03:48):
there was a lot of GLP one news this week.
New GLP one drugs approved, some new research on dosing.
What is your favorite piece of GLP one news for
the week.
Speaker 1 (04:03):
I mean, I think it's got to be the approval
of the new oral GLP one pill. It is the
hardest thing to pronounce the generic name or for glepron
terrible or forglepron. The brand name is FOUNDEO, which is
a little bit easier from Lily, is now FDA approved
for people with obesity or overweight with at least one
(04:26):
comorbid condition. This is a GLP one drug interacts with
a GLP one receptor, but it's not a peptide. Go
back to the peptide episodes to hear about how what
is a peptide. FOUNDEO is a small molecule that does
interact with the receptor, but not the way the peptide does,
so it's its own new thing.
Speaker 2 (04:46):
And the weight loss on this oral is a little
bit less than in the studies than we've seen with
something like zep bound, so maybe more like thirteen percent
rather than about twenty which is what you're seeing with
zep bound. But obviously or dosing far far easier for
many people than injection based dosing.
Speaker 1 (05:05):
Yeah, I think this lowers the barrier so much. I
anticipate this will be used pretty broadly. Right now for
cash pay patients, they're pricing this at like three hundred
and fifty dollars a month, that's still pretty pricey, but
you know, most insurance plans will cover this if you have,
you know, an appropriate condition.
Speaker 3 (05:23):
Where do they come up with these names? Is my
main question?
Speaker 2 (05:26):
Like who thought or or flogged leaparon was a good
even as a generic I don't love it.
Speaker 1 (05:32):
There are actually weird rules like for generic names, like
they have to have certain combinations of letters depending on
what type of drug they are, So I suspect the
like g l ip in there like has to be
in there for some reason, and then things get kind
of thrown together.
Speaker 3 (05:45):
But can't just be like skinny pill, skinny.
Speaker 1 (05:49):
Pill, skinny riz or something skinny ris that could be
a brand name trademark, don't take it.
Speaker 2 (05:57):
Second piece of GLP one news, which I think was
not very surprising, but there is a retrospective case series
that suggested that people can keep weight off in a
maintenance phase with reduced frequency dosing of GLP ones. In
the case of this case series, they were talking about
(06:20):
dosing every other week rather than every week. This isn't
very surprising since everyone is already doing this anyway, sometimes
with the permission of their doctor and sometimes not. But
I think it is the first of what's likely to
be a more rigorous set of studies looking at what
is the long term maintenance approach to GLP ones, since
(06:41):
we know people go totally off them, they regain a
lot of weight, but most people don't want to stay
on the higher dose forever. So I think we'll see
we'll see more of that as this becomes just a
more mature market and a more mature set of science.
Speaker 1 (06:54):
Yeah, couldn't agree more. I could see a little bit
of data coming through, but I agree. Not not super newsy,
but it's to know at least that there weren't, you know,
crazy adverse effects and that people kept the weight off
with that reduced dozing.
Speaker 3 (07:06):
All right.
Speaker 2 (07:06):
Two other small things that I want to get your
thoughts on. One is that benzyl alcohol has been named
the Allergen of the Year by the American Contact Dermatitis Society.
Speaker 1 (07:20):
Congratulations benzyl alcohol.
Speaker 2 (07:23):
Until all the nomination, wondering who were the other who
are the other nominees?
Speaker 1 (07:27):
Uh?
Speaker 3 (07:27):
Well, who are the other nominees for Allergen of the year? Uh?
What is this? Why do people do this?
Speaker 1 (07:34):
I think it's I have this like passion for very small,
insular groups of people. That care a lot about their
very small, insular thing. Like I love like niche conventions
where they're talking about like you know, new shoelace design
(07:54):
or something, and people are having these heated arguments. But
so contact dermatitis this is important. I don't mean to
make fun, but having an allergen of the Year is
kind of funny. Contact dermatitis is a rash you get
on your skin from it being in contact with a
potential allergen. And what the Contact Dermatitis Society is trying
to get us all to talk about by labeling benzyl
(08:16):
alcohol as their Allergen of the Year is that this
is not a widely recognized allergen, although it is quite common.
So this is an alcohol that's kind of like a floral,
pleasant flowery smell, and so it's added to a lot
of like fragrances and beauty products, particularly to give that
(08:36):
kind of like floral fragrance. And it's not tested for
in the standard skin testing for dermatitis. And so if
you know you're one of the people that gets like
weird reactions on their skin to something, and even if
you've been to a doctor and maybe gotten some patch
testing that hasn't revealed a particular allergen. You know, think
about benzyl alcohol.
Speaker 3 (08:58):
Think about ben'syl alcohol. It's it's having a moment.
Speaker 2 (09:02):
I also love niche societies as an economist. You know,
we have our own niche societies here and it's a delight.
Speaker 1 (09:10):
Absolutely. Another niche thing that is, I guess getting quite
a bit less niche right now is is kratom. And
I might not be pronouncing that correctly. Kratom KRATM is
a substance that you can buy at like gas stations
and stuff like that. It's not illegal as of yet,
but calls to poison control have gone up by about
(09:35):
twentyfold over the past fifteen years or so. From the substance.
What it is is a chemical that is a partial
agonist of the MEW opioid receptors, and that means that
it binds to the same receptors as things like heroin
and morphine. It's a partial agonist, so it's not quite
as strong, which is I think why it hasn't risen
(09:57):
to the level of like a national crisis yet. It
has some weird dosing effects where like low doses cause
sedation but higher doses cause agitation. Bit of a strange drug,
but want to call it out there, you probably just
in general, should not be taking anything that you buy
at the gas station.
Speaker 2 (10:15):
I don't disagree with that, I will say, you know,
I saw this in the CDC's MMWR, which is a
great publication that I enjoy, and they are tracking changes
in exposure from twenty fifteen to twenty twenty five and
looking at the increase in exposure and they have this number.
There's a twelve hundred percent increase in exposure reports, which
(10:37):
of course over this ten year period, which of course
is a lot, but it does start at two hundred
and fifty eight and goes up to three thousand and
five hundred, so it's worth remembering. You know, there are
three hundred and thirty million people in America now, not
all of them are purchasing this kratum kreatum item at
the gas station, but this is still a fairly small number,
(11:00):
although the percent increase is very large.
Speaker 1 (11:02):
So, yeah, getting more popular, don't take.
Speaker 3 (11:05):
It getting more popular.
Speaker 2 (11:06):
And I agree, purchasing psychoactive substances at the gas station
to take is probably just like not something that you
need to be doing, So don't do that.
Speaker 1 (11:14):
Pass on, let's forget.
Speaker 3 (11:15):
You can buy gum.
Speaker 2 (11:16):
If you need anything, purchase some gum, sure free gum.
All right, So that's it for the health news of
the week. When we come back, we will talk about protein.
Speaker 1 (11:28):
So Emily, I'm old enough to have lived through like
multiple macronutrient fads. I remember the low fat craze and
then the low.
Speaker 3 (11:38):
Carb phrase bacon only, bacon only.
Speaker 1 (11:41):
Keto, bacon only. These were the happiest days of my life.
You know, it was good. But like, clearly we are
in the protein phase right now, right this is this
is protein's time.
Speaker 3 (11:55):
It's protein's moment, at least one of its moments.
Speaker 2 (11:58):
You know, I could be drinking protein coffee right now
that I could make with protein water, and I could
have protein popcorn on the side.
Speaker 3 (12:06):
And that seems notable because in the past.
Speaker 2 (12:10):
You've really only been able to get protein out of
regular protein sources and not out of your water. But
now you can get it in your water. And the
question is is that good?
Speaker 3 (12:20):
Is that good?
Speaker 1 (12:21):
Is that good? Let's let's figure it out, am my
personal scale protein and water. I like that metric. I like,
if it is in your water, then it is having
in a moment caffeine maybe had its moment too. Now
that can get calculated water. My metric is Costco. So
I don't know if you've been in Costco, but that
like snacky aisle that you walk down to get the
(12:42):
bulk snacks for your kids lunches and stuff. Or you
probably don't because you're a good mother, and but I do,
and I don't have a Costco.
Speaker 3 (12:49):
Near here unfortunately, which is very sad.
Speaker 1 (12:52):
Well, in my Costco, the entire aisle is protein. Like
it says protein on every single snack thing, and they
know what they're doing, so yes, it is the protein.
Era is that good?
Speaker 3 (13:07):
Is that good? So let's before we get into is
that good? Or how much?
Speaker 2 (13:10):
And I think people have some pretty basic questions like
do I actually need as much as people say? And
could I have an infinite amount of protein? But let's
like start at the beginning, because I think at all
of these conversations there is a moment when you almost
don't want to ask like what is this? You know,
when you're like snacking on your protein powder. You got
to start at the top.
Speaker 3 (13:31):
So let me start by asking you just what is protein?
Speaker 1 (13:35):
Yeah? Such an important question? What is protein? Okay? We
often talk of the three macro nutrients, so carbohydrates, which
is sugars and starches, fats, fats and oils and things
like that, and then this protein thing. And protein is
far and away the most interesting of the macro nutrients
for a number of reasons.
Speaker 3 (13:57):
It seems so like judgment. That seems so judgement.
Speaker 2 (14:00):
All right, convince me, convince me. I love carbonydrate, so
I'm not really sure that I believe you.
Speaker 1 (14:05):
That's why they're interesting. Carbohydrates are really simple. You know,
they're sugars, or they're sugars that are stuck to other sugars.
It's like building a tower of lego blocks with the
same shape, you know, all the way up. That's all
you can do. Fats are somewhat similar. Carbohydrates and fats
both stores of energy get broken down into energy which
(14:26):
your body can use, and only two things water and
carbon dioxide. So you completely excrete all the product of
fat metabolism and carbohydrate metabolism by breathing and I guess
peeing if you want to get rid of the excess water. Now,
proteins are really complicated, So you go back to high
school biology, you'll remember that proteins are comprised of these
(14:49):
different amino acids, and there are really kind of twenty
common amino acids that humans use. There are twenty two total.
If you really search, you can find an extra two
amino acids, but they're basically twenty amino acids, which are
the different lego pieces that you can put together in
any different combination you want to make any different protein
you want, which is why proteins make up all of
(15:11):
the stuff of our body. You know, your skin is protein,
and your muscle is protein, and your hair is protein
or products of protein, and it's incredibly complicated. And when
you break down protein, you don't just get water and
carbon dioxide. You get water, carbon dioxide and other stuff
amino acids and ammonia, which is highly toxic, and that's
(15:33):
something that we might have to come around to now.
Of course, your body has ways to deal with that
toxic stuff. We can metabolize protein, but it's pretty interesting.
The other interesting thing about all these amino acids is
that nine of them are what are called essential, and
essential amino acids are amino acids that you cannot synthesize
(15:54):
in your own body from any chemicals that exist naturally
in your body or from other amino ass acids that
you take in. In other words, these are amino acids
that if you don't get them into your body, you
will die. Nine of them are like that. So nine
amino acids. Nine components of protein act similarly to vitamins,
such that if you didn't have enough, and you don't
(16:16):
need a ton, but if you didn't have enough, it
would be fatal. And that's not the case for carbohydrates
or fats. In general. You need some carbohydrate and some
fat to sustain life, but it doesn't particularly matter which
one or which source. That's why they're so interesting, all right.
Speaker 3 (16:32):
So fine, they seem interesting.
Speaker 2 (16:35):
Another way to say this is that I could in
principle live on carbohydrates and protein with almost no fat
or very little fat. And I could also live on
fat and protein with very little or no carbohydrates. But
I could not live on carbohydrates and fat without some protein.
Speaker 1 (16:55):
That's absolutely right, And there is a condition pure protein malnutrition.
So these are people who have adequate caloric intake from
carbohydrates and potentially fats, but not enough protein. It's called
quashy or core. But where you have seen it are
those if you remember those old advertisements of this, like
(17:17):
quote unquote starving kids in Africa with the big bellies.
So that big belly is filled with a fluid leaking
from the liver because there's no protein in the body
to retain that fluid. It's called ascid's And that is
not starvation, not pure starvation. It is protein specific starvation.
So there is a disease syndrome associated with pure protein malnutrition.
(17:39):
I will say that you also die if you only
eat protein, and there are cases of this. You go
into keto acidosis if you don't have any sugar or
fat at some point, and this has been reported in
some very rare people who have been living like exclusively
on highly lean mind like rabbit meat. So there are
(18:02):
people living in the wilderness who like only eate rabbits
for thirty days or something, and you can actually die
of that as well.
Speaker 3 (18:07):
Don't you think at that point you'd also have scurvy?
Speaker 1 (18:10):
You would almost certainly have scurvy, But I think it
takes a bit longer.
Speaker 2 (18:13):
To get scurvy. Yeah, okay, we can do another episode
on scurvy.
Speaker 1 (18:18):
Yeah, a lot of our time, certainly, not a lot.
Speaker 2 (18:21):
Of people have it, but if you have it, it's
not good. Okay, So back to the product. Protein is
a thing that we need. We need a good solid
amount of because of these amino acids, particularly the nine
amino acids. Is any type of protein going to give
us the nine essential amino acids?
Speaker 1 (18:43):
Short answer is yes, we don't have to worry about
this too too much, And I think this can transit
provided you eat an adequate total amount of protein. Most
stuff you're going to get out there is comprised of
enough variation in amino acids that you'll cover your bases.
But this leads to the I think central question that
we're all asking ourselves. Certainly I am since I started
(19:05):
writing down what I'm actually eating from day to day,
which is, wait a second, how much protein am I
supposed to have? So Emily, I want to turn this
to you. How much protein does the government say we
need to have? And then I want to know how
much protein you have?
Speaker 2 (19:22):
Okay, So I will tell you that I hate this
question and I feel like it is the first question
people are like, how much protein.
Speaker 3 (19:29):
Should I have?
Speaker 2 (19:31):
And I think that that question is like fundamentally really
really flawed.
Speaker 3 (19:35):
So I will tell you what the government says.
Speaker 2 (19:36):
The government has a like recommended daily allowance, and it
is zero point eight grams per kilogram per day.
Speaker 3 (19:44):
So that's about a.
Speaker 2 (19:45):
Third of a gram of protein per pound. So if
you're a person who weighs like one hundred and eighty pounds,
that would say you should have about sixty five grams
of protein a day. That is actually not that much,
and most people in the U get that amount. So
I looked in preparation for this discussion, I looked at
the en Haines data, which is a national longitudinal representative study,
(20:10):
and they ask people about their diet and they calculate
their protein. And the average woman has studies getting about
seventy five grams of protein to day. The average man's
getting a little over one hundred. So that is actually
plenty of protein based on the government recommendations.
Speaker 1 (20:24):
And that recommendation, correct me if I'm wrong, is essentially
based on these calculations of like, if you fall below
this for a sustained period of time, you will actually
like get into worse health or potentially have malnutrition.
Speaker 2 (20:38):
Yeah, so this comes out of the recommended daily allowance,
which is a number that the government has designed in
order to tell basically an institutional like if you had
an institutional population, you know, you were like feeding people
at a jail, and you were controlling like how many
calories you would have available, and how much protein and
(21:00):
how many micronutrients they have, these numbers of which you know,
this is like this is one of them. And the
idea is that this is going to like this would
be enough for people to be healthy and like lead
a healthy institutional lifestyle.
Speaker 3 (21:18):
That's the basic idea.
Speaker 1 (21:19):
Let's say I want to do a little bit more
than be a healthy a healthy member of some institution.
Speaker 2 (21:25):
All right, let's sort of say like sixty five grams
if you're a person in one hundred and eight pounds,
like sixty five sixty grams of protein to day is
actually not that much. So a cup of Greek yogurt
has like twelve grams of protein. Chicken breast, a sort
of standard sized chicken brass, has probably thirty grams of protein.
So this is like, you know, you could get to
sixty grams of protein pretty easily, which is not surprising
(21:48):
that most people are there.
Speaker 3 (21:51):
The question then is like is that enough?
Speaker 2 (21:53):
And this is the discussion, like sort of out in
the world where people are telling you look or people influencers,
you know, fitness enthusiasts will say, you know, point a
grams per kilogram is nowhere near enough. A number that
often gets thrown around is like one gram per pound
of body weight. So that would mean for someone of
one hundred and eighty pounds, rather than take having sixty
(22:14):
five grams a day, you should have one hundred and
eighty grams a day. And that's a lot more than sixty. Obviously,
that is a ton ton of protein. Yeah, it's a
ton of protein.
Speaker 3 (22:24):
And I think the core question for people is, like,
is that something I need to be prioritizing in part
because like, that's work. Like to particularly to get.
Speaker 2 (22:32):
One hundred and eighty grams of protein while also not
consuming like four hundred billion calories is challenging. Right, When
people say get all this protein, they don't mean like
and also get an equivalently larger number of carbohydrates in fat.
They mean like, prioritize protein relative to those and that
takes effort.
Speaker 1 (22:51):
Right, So if we are pursuing that kind of goal,
and I tried it a little bit, I tried to
think to myself and it does take planning. It's like, okay, wait,
what am I going to have for lunch? And how
am I going to get all this protein in? And
you're looking for foods that are, you know, how per
calorie have a lot of protein in them. And one
rule I sort of saw that does work out fairly
(23:12):
nicely is that if you take the grams of protein
in a food and you multiply it by ten and
that's more than the calories in the food, then it's
like a high protein food. So for example, if you
know there's ten grams of protein in a one hundred
calorie portion, then that's a high protein food. And that
works out to about forty percent protein per calorie, which
(23:34):
is like that seems about right to me, But it's
actually quite hard to even all those protein bars and
stuff at costco like don't necessarily get to that level.
Speaker 3 (23:46):
Yeah, I think so, I think we should talk about
how to get to that level.
Speaker 2 (23:48):
But I think we should also we should start by
talking about, like what are the scenarios in which you
would want to get to a higher level of protein. So,
because I think again getting back like the question of
than asking what is the right amount of protein, I
think the first question people should say is like what
is their goal?
Speaker 1 (24:05):
What is your goal?
Speaker 3 (24:06):
And I think there's a few different goals people have.
Speaker 1 (24:08):
Let me give you my goal. I want to know
about building muscle. I want to I'm in my forties
and I'm looking to get a little.
Speaker 2 (24:17):
Bit mid mint to late forties, Perry, you.
Speaker 1 (24:21):
Know who's counting. I'm in my mental late forties and
I'm hitting the gym, and the guys there are I
will say, very into protein. So what's the evidence there
is protein supplementation good for muscle? It makes sense, right,
Protein blocks supplement is the building block of muscle. That's
what I learned in biology.
Speaker 2 (24:43):
This is the place where I think the evidence the
sort of most clear that protein is key to building muscle.
And if you are either a person in your mid
to late forties who is looking to build some muscle,
or and I think this is important if you're an
older person who is trying to maintain muscle mass. Hard
to build my muscle when you're you know, in your
sixties and seventies, but you can maintain muscle. It's really
(25:03):
important for like not falling down. And we have a
fair amount of good evidence, particularly in these older populations
that having a higher amount of protein relative to these
you know, recommendations. But having more protein can maintain muscle
mass and can improve people's health.
Speaker 3 (25:24):
But and this is I.
Speaker 2 (25:25):
Think like the most important thing. It is not just
eating the protein. You also have to exercise. Right, Like
we talk about the protein, like you eat the protein
and then it like magically turns into muscle.
Speaker 3 (25:37):
That's not how it works.
Speaker 2 (25:38):
You eat the protein and you do resistance training some
kind of exercise, and those together make more muscle. So
if you're gonna you perry, you are going to go
to the gym and stand there and watch the other
guys while you eat a protein bar. Nothing will happen
except you will just be a person who's eating a
protein bar.
Speaker 1 (25:55):
It's such a good point. And I will say that biologically,
when your body breaks down that protein into its constituent
amino acids, there are two pathways that those amino acids
can go down. One pathway is those amino acids get
incorporated into a new protein like a muscle fiber. The
other pathways that those amino acids gets further broken down
into sugar and you get calories out of it, and
(26:18):
your body is more than willing to get calories out
of anything you put into it if you're not using
it for some other purpose, So absolutely you got to
actually use it. Do you have any opinion about this,
like should I be doing protein supplementation before workout after workout?
Is that superstition?
Speaker 3 (26:35):
I have a lot of feelings about that.
Speaker 2 (26:38):
In general, it doesn't matter so most people, it actually
doesn't matter much in the data. This is a place
where we have pretty good data because it's actually very
easy to study people who are doing endurance sports or
any kind of sports, because they love to be studied,
and they're looking to optimize their protein intake in various
ways because they're lunatics. When you look at that those populations,
(27:02):
it doesn't matter what time of what. When you had
people tell you have to have your protein shape within
like thirty minutes after a workout is just not supported
by the evidence.
Speaker 3 (27:10):
You want to kind of have it within a day.
Speaker 2 (27:12):
But if we're thinking about over the course of a day,
it doesn't that whether you get all your protein, even
like all at once versus in multiple chunks, doesn't seem
to impact the performance.
Speaker 1 (27:24):
That's been something people have been worried about for a
long time. Was this idea that there's like protein overflow,
like if you took too much in at once, you
wouldn't use it and the excess wouldn't get used appropriately.
Not much evidence for that.
Speaker 2 (27:37):
Not much evidence for that, certainly over a course of
like a twenty four hour period.
Speaker 1 (27:41):
I want to move on from muscle because there's some
other interesting protein stuff out there, But before we do,
we should probably talk about the specialist of the amino acids,
which is leucine. So leucine is this amino acid that,
unlike all of its nineteen brethren that found in protein,
has a signaling effect in muscle. So in your body,
(28:04):
there are all sorts of signals that your body reads
to know how to grow and how to change, And
muscle has a signaling receptor for leucine. And it seems
like lucine may be the thing that muscle uses to
know that there's a lot of protein around, right, Like,
how does your muscle know it's safe to sort of
build more muscle? And there's some evidence that the signaling
(28:26):
molecule for muscle reading your nutritional status from a protein
perspective is this particularly meino acid, leucine because of that,
you see leucine supplement supplements out there. We've started to
see a few loucine supplement studies in terms of muscle
building with mixed results. But I wanted to bring it up.
(28:47):
There's not a good natural source of lucine beyond anything
else that has a lot of protein. So like chicken
breast has plenty of leucine in it, beans have lucine,
cottage she has lucine. Wherever you're getting your protein and
you're getting your lucine. But supplementation is always different, right
because now we're talking about something that's processed. You're getting
super physiologic doses, and we're starting to see that. Have
(29:09):
you had people coming to you talking to you about
lucine yet or is this still on the edge.
Speaker 2 (29:13):
I think this is still on the edge, and people
ask me a lot about protein in general.
Speaker 3 (29:16):
But even it's interesting.
Speaker 2 (29:18):
So I consume, as people will learn if they listen
to this podcast more. I consume a lot of endurance
sports content and even there you will see some discussions
of sort of lucine supplementation, but I think not as
much as you would get it. Like body, My guess
is in the body building space. This gets a lot
of discussion because the core there is muscle building.
Speaker 1 (29:41):
Yeah, yeah, so keep an eye out for that. We
might end up talking about lucine again in the future
if we ever get to wrap a micin and aging.
But speaking of aging the aging brain, so I'm willing
to concede that to build muscle you probably need to
have adequate prote ten intake. You probably need to have
(30:04):
are there recommended? Before we move on? Sorry, can you
give me a number like I is my one hundred
and fifty that I had that day? Is that a
good target for me? Clearly more than the sixty I
had when I just state mac and cheese.
Speaker 2 (30:16):
Yeah, I mean, I think a lot of a number
that a lot of people talk about is two grams
per kilogram or one point six grams per kilograms, So
that would put people in more like you know, somebody
like you, more like one.
Speaker 1 (30:28):
Hundred little less than a gram per pound.
Speaker 2 (30:30):
Little less than a graand per pound. A grad per
pound is a lot of protein. I think many of
these things go for one point six.
Speaker 1 (30:36):
All right, So I need to find some good ways
to get me today. Yeah, all right, So let's talk
about brains a lot of studies of protein supplementation have
focused on more older people, elderly people, particularly the frail elderly,
with some interesting results. One I pulled out of the
ether here a little bit was a trial called the
(30:57):
pro Muscle Trial smallest set sixty five frail elderly people
who were randomized to get supplementation with milk protein. Not
sure if milk protein is different than just way protein,
but it was described as milk protein thirty grams a
day in two doses versus just a placebo Emily, you'll
(31:18):
be happy to hear they both groups got resistance training.
Speaker 3 (31:21):
You have to do resistant Okay, of.
Speaker 1 (31:23):
Course, yes they they both got resistance training. But the
group randomized to the protein supplements at the end of
the trial, which was a couple months, had one point
three kilograms additional lean body mass and had a one
point improvement on the short physical performance battery, which is
sort of a variety of exercise based tests. So not
(31:45):
like amazing, but you know, a nice randomized trial we
like to see that seem to work. No particular difference
in their cognition or.
Speaker 2 (31:56):
Memory that would be consistent with the rest of my
reading of this, which is that the impacts on dementia
and so on are small or zero. I think what
sort of interesting and nuanced about that? Is my sense
from other pieces of data, is it staying like active
and engaged with the world is very good for your cognition.
(32:20):
So if consuming more protein and doing some resistance training
makes you able to walk around more and you know,
pick up your grandkids and not be bed ridden, that
could actually be good for your cognition, just because it
enables activities which are themselves good for cognition. So is
there a mechanistic effect through the protein affecting your brain.
Speaker 3 (32:39):
Maybe not. Is there a causal effect because it goes
through these other pathways.
Speaker 1 (32:43):
Maybe there is, I like the off target effects, the
knockout effects. Let's move on to the third scenario that
I like to think about when I'm thinking about protein intake,
which is can of helping lose weight. So protein I
have been told is good for satiety. It's a little
harder to break down, certainly than like a simple carbohydrate
(33:05):
which is going to give you that boost of energy
and then begone and then you're hungry five minutes later.
So I can make a biologic plausibility argument that proteins
will help you lose weight. Do you think they really
does A higher protein diet, I should say, really help
you lose weight, all else being equal, calorically.
Speaker 2 (33:22):
Speaking, look, maybe a little bit in the short term.
In a very core fact about diets is that they
mostly don't work in the long term. Most dietary changes
can cause people to lose some weight in the short term,
and then mostly they gain it back in the slightly
longer term. To the extent that protein causes you to
(33:46):
feel more full and makes it easier for you to
stick to the diet, then okay, that could make it
more effective, but this is not a game changer.
Speaker 1 (33:54):
I mean.
Speaker 2 (33:54):
And I also find this discussion at this point like
if people want to lose significt get amount of weight,
they should go on a GLP one And that's just
what it is.
Speaker 1 (34:06):
I tend to agree with you. I think all the
successful diets tend to be transient, and they all share
one thing in common, which is that it makes it
harder to eat food. And so you know, if you
look at Atkins or something, you know these keto diets,
like it just is harder. You have to think more
about what you eat. You have to plan a little
bit more, and I think high protein diets. My personal
(34:29):
experience as I've started to look around and like get
more protein into the food I eat is the same thing.
I'm like, oh no, I can't eat that. You know
that those chips are not you know, there's no protein
in there, and I need to find a source that
gets my protein. So I think whenever you make it
difficult for people to eat, yeah, protein chips would be
you know, but if you make it difficult for people
to eat, you're always going to lose some weight. I mean,
(34:51):
I will say there was a just to pull out
a randomized trial, you know, there is some evidence of
weight loss. There is a twenty ten study which randomized
and men with diabetes to a thirty five percent protein
diet to it versus a fifteen percent protein diet. They
were both calorie restricted. So that's that's another thing you
have to account for. Like, as you said, Emily, if
(35:12):
you eat more protein, but by eating more protein, you're
eating thirty percent more calories, You're you're definitely not going
to lose weight, right. But in this calorie equalized environment,
the men who randomized to the protein that had about
a three kilogram extra weight loss after four months. This
is not impressive in a world that has GLP ones,
(35:34):
I understand, but as we said, not everyone has access
to GLP ones. Everyone has access to protein.
Speaker 3 (35:39):
We hope agreed.
Speaker 2 (35:40):
I will say there is an addendum here in the
GLP one space, which is to the extent that people
are on a GLP one, you know, that makes you
eat less. And as we said at the top, protein continues.
Speaker 3 (35:52):
To be very important.
Speaker 2 (35:54):
And so to the extent that you are on a
GLP one and trying to lose weight and do.
Speaker 3 (35:59):
Not want to lose muscle mass, you.
Speaker 2 (36:02):
Do need to prioritize getting a larger share of your
calories from protein, because you basically want to keep your
protein more similar to where it was and drop other things.
And I think that can be a challenge for people
when they're sort of not hungry and they just kind
of don't want to eat anything. It's not just eating less,
it's changing the balances of food.
Speaker 1 (36:22):
This is what I want to hear from you as
we as we wrap this up. My wife has terminator
vision for food, Like she can look at a plate
of food and tell you, like, how many calories, how
many grams are fat? How many grams of protein? I
don't know if all women have this. I'm not sure
if it's built in.
Speaker 3 (36:38):
We developed it.
Speaker 2 (36:39):
We've developed it all women in our in our mid
to late forties. We developed this a long time ago,
and we're retaining that skilled ye accurating a bike.
Speaker 1 (36:46):
Like I will, I will take a package that has
the nutritional information and she will be able to do
it. It's very impressive. I cannot do that. I know that. Intellectually.
I'm like, oh, yeah, chicken, that's good. But let's say
I decide, you know what I'm going to go for it.
I'm going a gram per pound a lot of protein.
I don't think I can make it. What are your
tips for me? And maybe I'll make it even simpler?
(37:11):
Is there any way to do this short of me
buying in bulk some can of protein powder, whether it's
weigh powder or soy powder or you know, wheature, whatever
it is, and adding it to things and making shakes?
Or can I do this with food as it exists
in reality?
Speaker 3 (37:27):
So we term doesn't have a lot of protein, So don't.
Speaker 1 (37:30):
Vi weat gluten? Sorry weak gluten?
Speaker 3 (37:33):
Oh good lord? Okay?
Speaker 2 (37:34):
So uh So I will say I think for most people,
if you are attempting to get something like a gram
per pound of body weight, which again is a lot
even for a pretty small person, is a lot, you
will need to use some kind of protein powder, something
(37:57):
some kind of thoughtful of pro coach, which probably involves
supplementation with not real food. You know, think about like
a protein shake, you know why. Protein shake probably has
can you know, can have twenty five grams of protein.
That's like a whole chicken breast pretty much. And it's
just hard for people to consume enough whole foods to
(38:18):
get that kind of protein without also adding a lot
of fat and carbohydrates. So I will say, you asked
me at the top, how much protein do you eat
in a day? I do eat about a gram of
protein per pound of body weights. That's about one hundred
and thirty ish grams of protein a day. And the
only way that I can achieve that is by consuming
like a large protein shake in the morning.
Speaker 1 (38:39):
And what is the protein? Is it way protein?
Speaker 2 (38:41):
Typically that it's just way breakenth yeah, just way protein.
All right, all right, So now here's my question for you.
We have revealed that I'm a crazy person who drinks,
who eat, consumes a lot of protein, and I should
say I just I want to say. The reason that
I consume a lot of protein, getting back to these
questions of like why are you doing this, is that
I take myself infinitely too seriously with sports. I'm like
(39:02):
a pretend elite athlete, a person who pretends to be
an athlete, and I so I run a lot and
I consume a lot of protein in service of that.
Speaker 3 (39:11):
So that is my that is my reasoning.
Speaker 1 (39:13):
So not for everyone, but not for people.
Speaker 2 (39:16):
Like you people crazy people. So here's my question. Can
you have too much protein? And what would happen?
Speaker 1 (39:24):
So yes, as a medical doctor, yes you can. So
a couple of things.
Speaker 3 (39:30):
You're a kidney doctor, I'm a kidney doctor, specifically good.
Speaker 1 (39:34):
Particular yes, yes, no, this is this is certainly right
up my alley. So so yeah, I mean, first of all,
if you only had protein to the exclusion of all
other macro nutrients, you die. We talked about this, very
difficult to do unless you're only eating rabbit meat, so
I'm not too worried about that. But from a kidney standpoint,
the data is quite compelling that more protein intake puts
(39:56):
more stress on the kidneys. And I'm pausing on the
word stress, because what exactly do I mean by that.
We measure kidneys filter the blood, and we can measure
the rate at which they filter the blood in milli
liters per minute, and for a healthy person it's about
one hundred millimeters per minute, which means that you're cycling
through your entire blood volume dozens and dozens of times
(40:19):
a day with your kidneys cleaning that, which is great.
Acute protein intake increases that filtration rate so from one
hundred to one hundred and ten one hundred and twenty
mili liters per minute, and you might think great, you know,
like that's more filtration now. Of course, the reason your
kidneys are doing that is because, unlike carbohydrates and fat,
(40:40):
proteins are metabolized into ammonia, and ammonia needs to be excreted.
It's excreted as this thing called urea, which is where
urine gets its name. But urea is the way that
urine excretes ammonia. You have to increase filtration to get
rid of the ammonia load. There is data in people
with kidney disease that low protein diets protect the kidneys
(41:03):
in the long term. That's been well established. In fact,
up until about ten years ago, we would routinely recommend
people with kidney disease to decrease their protein intake for
just this reason. Nowadays I don't do that, in part
because of what we've talked about. I'm also worried about
their muscle mass and their health and their ability to
(41:25):
move around and get exercise, and I don't like telling
people to restrict, but I certainly don't tell my patients
with kidney disease to like supplement protein. And the reason
it seems that your kidneys are better off when they're
not stressed like this, when they're not forced to increase filtration,
is that there's a finite amount of tread on the tire,
(41:47):
and at least for people with underlying kidney disease, forcing
them to run at one hundred and ten percent one
hundred and twenty percent capacity just stresses them out more
and you lose kidney function faster. What I don't know
if is that's true for people without any kidney disease.
We don't have long term data a very high protein
(42:07):
intake to suggest if that alone in the absence of
other diseases is going to affect kidney function, but it
clearly does in people with underlying kidney disease.
Speaker 2 (42:15):
I think the other piece of the we will never
know the answer to your last question, I think because
the kind of people who are consuming very high amounts
of protein are also very different, correct, mostly healthier, but
just very different in other ways. So we would never
really be able to compare you know, the people who
having two and a half grams of protein per kilog
like these very high levels to lower levels, because you're
(42:38):
just going to.
Speaker 3 (42:38):
Find they're different in all kinds of other all kinds
of other ways.
Speaker 1 (42:40):
Yeah, there's a very hypothetical other risk which I will
just say that protein does have signaling effects, including that
lucine thing that signals muscles to grow. In the context
of muscle, we like growth, but there are other parts
of the body that we don't want to grow. And
so yourself in your body are kind of constantly under
(43:02):
balanced signals saying grow, divide like fill in this space,
you got to cut like heel at that kind of stuff.
Muscles get bigger, you know, fat cells grow like all
those kind of things, and signals that say no no, no,
stay quiet, stay where you are. We know when those
signals get out of hand and excessive growth signaling occurs
that that is a step towards cancer development and lucine.
(43:25):
This particular amino acid stimulates a molecule called m tour,
a million target of wrapamycin, which is a known cancer
promoting chemical in the blood. Now it also promotes muscle growth.
So and there are usually there are many steps to
(43:46):
getting cancer beyond just like, oh, your level of M
tour might be a little bit too high. So I'm
not as worried about this as I am about kidney
function and very high protein intake. But you know, for
interest of completeness, we should say that growth in and
of itself is not universally a good thing. Okay, that
is a ton of information about protein. Let's let's wrap
this up, Emily, protein smash or pass?
Speaker 3 (44:12):
I think this question is unfair.
Speaker 2 (44:13):
You need protein for life, so in that sense, I
would say I'm going to smash it as an essential
element of not being did I will say if the
if the question is do I smash getting even more
protein than you're getting now, I think.
Speaker 3 (44:30):
For most people I'm a pass on that. How about you.
Speaker 1 (44:35):
I'm I think a soft smash on this question of
getting extra protein. You know, I think probably we should
be more cognizant of the protein we take in. If
we can get some extra protein, especially if we're replacing
carbs in our diet, I'm down for that certainly. I
think my one concern actually is that we really should
(44:56):
be getting as much protein as possible from plant based
sources so we don't tank our fiber intake, which is
something we'll talk about in future episodes, especially when we
look at the arising incidents of colon cancer. So cautious smash,
but you don't have to go crazy about it.
Speaker 2 (45:11):
I feel like you're putting too many caveats into your smashes.
We have to be a committed Perry in future episodes.
Commit to smash your pass. There's a soft smash. All right, Fine,
that's it for protein your mail bag Question of the
week after the Break.
Speaker 4 (45:33):
Hi, Emile and Perry. My name is Natalie and I'm
from Boston. Have been listening to the podcast and I
heard you say that there's a lack of evidence on
the efficacy of shockwave therapy. I've received this treatment a
couple of times. For instances of tendonosis, and I was
really pleasantly surprised. Of course, I'm willing to accept the
possibility of the placebo effect, but my curse research of
(45:53):
the literature did turn up a few studies that seem
to support shockwave treatment. I would love to hear your
thoughts on this. Thank you so much. Hi.
Speaker 3 (46:03):
Shockwave therapy.
Speaker 2 (46:04):
Yes, so, I have spent a lot of personal time, Perry,
looking into this because I had a hamstring injury, hamstring tendinopathy,
and I was told that shockwave therapy would help for
those of you who are not you know, deep in
the well of this activity. What this involves, at least
in the sports context, is somebody taking a probe and
(46:26):
some gel and delivering like acoustic waves into your tissue.
It's quite uncomfortable, and the idea is that it like
boosts your cell metabolism and generates better repair. I will
say I did look into the data before I did this,
and there is some reasonable randomized data suggesting that this
(46:48):
improves healing speed in some tendonopathy related injuries, things like
achilles tennis elbow rotator, actually your rotator cuff, Perry, it
might help with that and I will say really helped
with my hamstring, although it's very painful. Like there's a
person doing this and they're like, what's your pain level.
Speaker 3 (47:08):
I was like, oh, it's like a four.
Speaker 2 (47:09):
He's like great, we're going for a seven, and then
they just like turn it up until you're like, ah.
Speaker 1 (47:15):
Just compared to that, my hamstring feels great.
Speaker 2 (47:18):
Exactly afterwards, you're like, oh, thank god it's over. So
a little bit of positive evidence on this.
Speaker 1 (47:24):
Yeah, we use it for kidney stones. Actually, I mean
this is sort of different, but you know, for small
enough kidney stones, you can send the shock weaves in
and they kind of break up like an opera singer
shattering a glass with her voice, and then you pass
the little pieces out, which is I guess better than
going up and retrieving them yourselves. Do you want to
know a little interesting physics?
Speaker 3 (47:45):
Yes, always so.
Speaker 1 (47:48):
An ellipse has two fox si. That's like how you
define the ellipse, Like two focuses two points inside the ellipse,
and every point along the outer edge of the ellipse
is equidistant from like the sum to the distance between
those focia is constant. That's what defines an ellipse. Okay, wait,
any time anything that goes through one focus bounces off
(48:08):
the edge of the ellipse and will go through the
other focus. And so for extra corporeal shockwave lithotripsy, they
put the sound emitting device, the ultrasound device, at one
focus of the ellipse, and then they curve the ellipse
that it's in. It's like a half ellipse, a shell,
so that's that sound bounces off and all of it
(48:30):
gets focused into the other focus of the ellipse, which
is somewhere inside your body. Isn't that kind of neat?
Speaker 2 (48:36):
That is incredibly interesting and physics is very neat, I
think no. Okay, So one question I think maybe people
have about the shockwave therapy is like, is this just
place ebo? Because of course we know the placebo effect
is one of the best effects, and it's hard to
know if something is real or sham. But actually, in
(48:57):
a lot of these studies of shockwave therapy they do
placebo sham shockwave therapy on people. I'm not really sure
how that would be involved and is it less painful?
So we always have to be careful about placibo effects.
On the other hand, my hamstring feels much better, So
I guess I don't care.
Speaker 3 (49:13):
Why is my fundamental answer? All right, that's it for
this week.
Speaker 2 (49:17):
Join us next week when we'll ask what's the deal
with continuous glucose monitors? Wellness Actually is produced in association
with iHeartMedia.
Speaker 3 (49:27):
Our senior producer is Tamar Avishai.
Speaker 2 (49:29):
Our executive producer at iHeart is Jennifer Bassett. Our theme
music is by Eric Deutsch, and our content is for
educational purposes only.
Speaker 1 (49:38):
If you like the show, help other people find us,
leave a rating and review on Apple Podcasts or your
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Actually pod and don't forget We want to hear from you.
Head over to Wellness Actually dot fm and leave us
a question for our mailbag or suggest a topic for
(49:58):
a future show.
Speaker 3 (49:59):
We'll let the influencers have the last word.
Speaker 5 (50:02):
This is why I'm jacked and you're not. It's because
I eat meals like this round beef and whole eggs,
pure protein and healthy fats, zero carbohydrates. This is what
I wish fat people understood if they just cut out
carbohydrates for two weeks. I'm talking zero grams to twenty
(50:22):
grams of carbs per day. They would lose ten pounds instantly.
Speaker 1 (50:27):
It's that easy.
Hey, everybody, Just a quick correction from last week. At
the end of the episode. In the mailbag, we were
talking about colon cancer screening and I said that the
colon guard test is done yearly. That's not right, It's
done every three years. The fit testing, which is another
forum of stool based testing, is the yearly colon cancer
screening test. Thanks so much to amazing doctor Clay Ackerley
for pointing that out for us. Now onto the episode.
Speaker 2 (00:24):
Hi, Perry, high, Emily, nice to see you, you too?
Which has more protein?
Speaker 3 (00:30):
Cup of cottage cheese or a cup of Greek yogurt?
Speaker 1 (00:33):
Oh? Why are you doing this to me? I am
going to say a cup of cottage cheese with low confidence.
Speaker 3 (00:39):
Excellent, one score of one. Okay.
Speaker 2 (00:43):
Second question, high demand for what product led to weigh
protein being primarily the source of protein for protein shakes,
cheese generally cheese is the correct?
Speaker 1 (00:58):
Okay?
Speaker 3 (00:58):
Cancer?
Speaker 1 (00:59):
All right of two?
Speaker 3 (01:00):
Okay, very hard. Last question.
Speaker 2 (01:03):
There is a new protein product called a David protein bar.
It has a lot of protein. The company that makes
it introduced a second product to expand their line. What
is that second product?
Speaker 1 (01:16):
It's gotta be Goliath.
Speaker 3 (01:21):
No, And that's on the table. They left that on
the table.
Speaker 2 (01:25):
The new product is frozen cod Oh, and that's all
you need to know about protein.
Speaker 1 (01:33):
Wow. So, I, in anticipation of this episode, for the
first time really ever, tracked everything I put into my body,
everything I ate for a few days because I had
no idea how much protein I was taking it. And
I will tell you two things. Number One, I don't
like writing down everything that I eat. It's annoying, it's
(01:56):
hard to search for I don't know what portion sizes
are and it makes me feel guilty. And two, the
amount of protein I intake from day to day varies
wildly and depends almost entirely on whether my kids are
having pasta for dinner or not.
Speaker 3 (02:12):
What was your protein number?
Speaker 1 (02:14):
So the highest day I had was one hundred and
fifty grams and the lowest day I had was sixty grams.
Speaker 3 (02:21):
Wow, that is a lot of variation.
Speaker 2 (02:23):
Yeah, I eat exactly the same amount of protein every
single day.
Speaker 1 (02:28):
I think that may say everything anyone needs to know
about the two of us. Should we dig into this?
Speaker 3 (02:34):
We should.
Speaker 2 (02:38):
I'm Emily Aster, I'm an economist and a data expert.
Speaker 1 (02:41):
And I'm Perry Wilson. I'm a medical doctor.
Speaker 2 (02:44):
It's Thursday, April ninth, twenty twenty six, and this is wellness.
Speaker 1 (02:48):
Actually, because you're getting a staggering amount of health and
wellness information nowadays from every source imaginable, and some of
it is awesome.
Speaker 2 (02:57):
And some of it is well actually both Fortunately we
are both people who know how to read studies, how
to parse the data, and can tell you what's worth
thinking about and what you can safely ignore.
Speaker 1 (03:10):
But before we dig in, a note that this podcast
is for educational purposes and should not be construed as
medical advice. We don't know your unique situation, so talk
to your doctor for personal health decisions.
Speaker 3 (03:22):
This week we're asking what's the deal with protein?
Speaker 2 (03:25):
Perry and I will give the official smash her pass
and then we'll get to your question of the week.
But first let's do the health news roundup after the break.
And now for the health news of the week, Perry,
(03:48):
there was a lot of GLP one news this week.
New GLP one drugs approved, some new research on dosing.
What is your favorite piece of GLP one news for
the week.
Speaker 1 (04:03):
I mean, I think it's got to be the approval
of the new oral GLP one pill. It is the
hardest thing to pronounce the generic name or for glepron
terrible or forglepron. The brand name is FOUNDEO, which is
a little bit easier from Lily, is now FDA approved
for people with obesity or overweight with at least one
(04:26):
comorbid condition. This is a GLP one drug interacts with
a GLP one receptor, but it's not a peptide. Go
back to the peptide episodes to hear about how what
is a peptide. FOUNDEO is a small molecule that does
interact with the receptor, but not the way the peptide does,
so it's its own new thing.
Speaker 2 (04:46):
And the weight loss on this oral is a little
bit less than in the studies than we've seen with
something like zep bound, so maybe more like thirteen percent
rather than about twenty which is what you're seeing with
zep bound. But obviously or dosing far far easier for
many people than injection based dosing.
Speaker 1 (05:05):
Yeah, I think this lowers the barrier so much. I
anticipate this will be used pretty broadly. Right now for
cash pay patients, they're pricing this at like three hundred
and fifty dollars a month, that's still pretty pricey, but
you know, most insurance plans will cover this if you have,
you know, an appropriate condition.
Speaker 3 (05:23):
Where do they come up with these names? Is my
main question?
Speaker 2 (05:26):
Like who thought or or flogged leaparon was a good
even as a generic I don't love it.
Speaker 1 (05:32):
There are actually weird rules like for generic names, like
they have to have certain combinations of letters depending on
what type of drug they are, So I suspect the
like g l ip in there like has to be
in there for some reason, and then things get kind
of thrown together.
Speaker 3 (05:45):
But can't just be like skinny pill, skinny.
Speaker 1 (05:49):
Pill, skinny riz or something skinny ris that could be
a brand name trademark, don't take it.
Speaker 2 (05:57):
Second piece of GLP one news, which I think was
not very surprising, but there is a retrospective case series
that suggested that people can keep weight off in a
maintenance phase with reduced frequency dosing of GLP ones. In
the case of this case series, they were talking about
(06:20):
dosing every other week rather than every week. This isn't
very surprising since everyone is already doing this anyway, sometimes
with the permission of their doctor and sometimes not. But
I think it is the first of what's likely to
be a more rigorous set of studies looking at what
is the long term maintenance approach to GLP ones, since
(06:41):
we know people go totally off them, they regain a
lot of weight, but most people don't want to stay
on the higher dose forever. So I think we'll see
we'll see more of that as this becomes just a
more mature market and a more mature set of science.
Speaker 1 (06:54):
Yeah, couldn't agree more. I could see a little bit
of data coming through, but I agree. Not not super newsy,
but it's to know at least that there weren't, you know,
crazy adverse effects and that people kept the weight off
with that reduced dozing.
Speaker 3 (07:06):
All right.
Speaker 2 (07:06):
Two other small things that I want to get your
thoughts on. One is that benzyl alcohol has been named
the Allergen of the Year by the American Contact Dermatitis Society.
Speaker 1 (07:20):
Congratulations benzyl alcohol.
Speaker 2 (07:23):
Until all the nomination, wondering who were the other who
are the other nominees?
Speaker 1 (07:27):
Uh?
Speaker 3 (07:27):
Well, who are the other nominees for Allergen of the year? Uh?
What is this? Why do people do this?
Speaker 1 (07:34):
I think it's I have this like passion for very small,
insular groups of people. That care a lot about their
very small, insular thing. Like I love like niche conventions
where they're talking about like you know, new shoelace design
(07:54):
or something, and people are having these heated arguments. But
so contact dermatitis this is important. I don't mean to
make fun, but having an allergen of the Year is
kind of funny. Contact dermatitis is a rash you get
on your skin from it being in contact with a
potential allergen. And what the Contact Dermatitis Society is trying
to get us all to talk about by labeling benzyl
(08:16):
alcohol as their Allergen of the Year is that this
is not a widely recognized allergen, although it is quite common.
So this is an alcohol that's kind of like a floral,
pleasant flowery smell, and so it's added to a lot
of like fragrances and beauty products, particularly to give that
(08:36):
kind of like floral fragrance. And it's not tested for
in the standard skin testing for dermatitis. And so if
you know you're one of the people that gets like
weird reactions on their skin to something, and even if
you've been to a doctor and maybe gotten some patch
testing that hasn't revealed a particular allergen. You know, think
about benzyl alcohol.
Speaker 3 (08:58):
Think about ben'syl alcohol. It's it's having a moment.
Speaker 2 (09:02):
I also love niche societies as an economist. You know,
we have our own niche societies here and it's a delight.
Speaker 1 (09:10):
Absolutely. Another niche thing that is, I guess getting quite
a bit less niche right now is is kratom. And
I might not be pronouncing that correctly. Kratom KRATM is
a substance that you can buy at like gas stations
and stuff like that. It's not illegal as of yet,
but calls to poison control have gone up by about
(09:35):
twentyfold over the past fifteen years or so. From the substance.
What it is is a chemical that is a partial
agonist of the MEW opioid receptors, and that means that
it binds to the same receptors as things like heroin
and morphine. It's a partial agonist, so it's not quite
as strong, which is I think why it hasn't risen
(09:57):
to the level of like a national crisis yet. It
has some weird dosing effects where like low doses cause
sedation but higher doses cause agitation. Bit of a strange drug,
but want to call it out there, you probably just
in general, should not be taking anything that you buy
at the gas station.
Speaker 2 (10:15):
I don't disagree with that, I will say, you know,
I saw this in the CDC's MMWR, which is a
great publication that I enjoy, and they are tracking changes
in exposure from twenty fifteen to twenty twenty five and
looking at the increase in exposure and they have this number.
There's a twelve hundred percent increase in exposure reports, which
(10:37):
of course over this ten year period, which of course
is a lot, but it does start at two hundred
and fifty eight and goes up to three thousand and
five hundred, so it's worth remembering. You know, there are
three hundred and thirty million people in America now, not
all of them are purchasing this kratum kreatum item at
the gas station, but this is still a fairly small number,
(11:00):
although the percent increase is very large.
Speaker 1 (11:02):
So, yeah, getting more popular, don't take.
Speaker 3 (11:05):
It getting more popular.
Speaker 2 (11:06):
And I agree, purchasing psychoactive substances at the gas station
to take is probably just like not something that you
need to be doing, So don't do that.
Speaker 1 (11:14):
Pass on, let's forget.
Speaker 3 (11:15):
You can buy gum.
Speaker 2 (11:16):
If you need anything, purchase some gum, sure free gum.
All right, So that's it for the health news of
the week. When we come back, we will talk about protein.
Speaker 1 (11:28):
So Emily, I'm old enough to have lived through like
multiple macronutrient fads. I remember the low fat craze and
then the low.
Speaker 3 (11:38):
Carb phrase bacon only, bacon only.
Speaker 1 (11:41):
Keto, bacon only. These were the happiest days of my life.
You know, it was good. But like, clearly we are
in the protein phase right now, right this is this
is protein's time.
Speaker 3 (11:55):
It's protein's moment, at least one of its moments.
Speaker 2 (11:58):
You know, I could be drinking protein coffee right now
that I could make with protein water, and I could
have protein popcorn on the side.
Speaker 3 (12:06):
And that seems notable because in the past.
Speaker 2 (12:10):
You've really only been able to get protein out of
regular protein sources and not out of your water. But
now you can get it in your water. And the
question is is that good?
Speaker 3 (12:20):
Is that good?
Speaker 1 (12:21):
Is that good? Let's let's figure it out, am my
personal scale protein and water. I like that metric. I like,
if it is in your water, then it is having
in a moment caffeine maybe had its moment too. Now
that can get calculated water. My metric is Costco. So
I don't know if you've been in Costco, but that
like snacky aisle that you walk down to get the
(12:42):
bulk snacks for your kids lunches and stuff. Or you
probably don't because you're a good mother, and but I do,
and I don't have a Costco.
Speaker 3 (12:49):
Near here unfortunately, which is very sad.
Speaker 1 (12:52):
Well, in my Costco, the entire aisle is protein. Like
it says protein on every single snack thing, and they
know what they're doing, so yes, it is the protein.
Era is that good?
Speaker 3 (13:07):
Is that good? So let's before we get into is
that good? Or how much?
Speaker 2 (13:10):
And I think people have some pretty basic questions like
do I actually need as much as people say? And
could I have an infinite amount of protein? But let's
like start at the beginning, because I think at all
of these conversations there is a moment when you almost
don't want to ask like what is this? You know,
when you're like snacking on your protein powder. You got
to start at the top.
Speaker 3 (13:31):
So let me start by asking you just what is protein?
Speaker 1 (13:35):
Yeah? Such an important question? What is protein? Okay? We
often talk of the three macro nutrients, so carbohydrates, which
is sugars and starches, fats, fats and oils and things
like that, and then this protein thing. And protein is
far and away the most interesting of the macro nutrients
for a number of reasons.
Speaker 3 (13:57):
It seems so like judgment. That seems so judgement.
Speaker 2 (14:00):
All right, convince me, convince me. I love carbonydrate, so
I'm not really sure that I believe you.
Speaker 1 (14:05):
That's why they're interesting. Carbohydrates are really simple. You know,
they're sugars, or they're sugars that are stuck to other sugars.
It's like building a tower of lego blocks with the
same shape, you know, all the way up. That's all
you can do. Fats are somewhat similar. Carbohydrates and fats
both stores of energy get broken down into energy which
(14:26):
your body can use, and only two things water and
carbon dioxide. So you completely excrete all the product of
fat metabolism and carbohydrate metabolism by breathing and I guess
peeing if you want to get rid of the excess water. Now,
proteins are really complicated, So you go back to high
school biology, you'll remember that proteins are comprised of these
(14:49):
different amino acids, and there are really kind of twenty
common amino acids that humans use. There are twenty two total.
If you really search, you can find an extra two
amino acids, but they're basically twenty amino acids, which are
the different lego pieces that you can put together in
any different combination you want to make any different protein
you want, which is why proteins make up all of
(15:11):
the stuff of our body. You know, your skin is protein,
and your muscle is protein, and your hair is protein
or products of protein, and it's incredibly complicated. And when
you break down protein, you don't just get water and
carbon dioxide. You get water, carbon dioxide and other stuff
amino acids and ammonia, which is highly toxic, and that's
(15:33):
something that we might have to come around to now.
Of course, your body has ways to deal with that
toxic stuff. We can metabolize protein, but it's pretty interesting.
The other interesting thing about all these amino acids is
that nine of them are what are called essential, and
essential amino acids are amino acids that you cannot synthesize
(15:54):
in your own body from any chemicals that exist naturally
in your body or from other amino ass acids that
you take in. In other words, these are amino acids
that if you don't get them into your body, you
will die. Nine of them are like that. So nine
amino acids. Nine components of protein act similarly to vitamins,
such that if you didn't have enough, and you don't
(16:16):
need a ton, but if you didn't have enough, it
would be fatal. And that's not the case for carbohydrates
or fats. In general. You need some carbohydrate and some
fat to sustain life, but it doesn't particularly matter which
one or which source. That's why they're so interesting, all right.
Speaker 3 (16:32):
So fine, they seem interesting.
Speaker 2 (16:35):
Another way to say this is that I could in
principle live on carbohydrates and protein with almost no fat
or very little fat. And I could also live on
fat and protein with very little or no carbohydrates. But
I could not live on carbohydrates and fat without some protein.
Speaker 1 (16:55):
That's absolutely right, And there is a condition pure protein malnutrition.
So these are people who have adequate caloric intake from
carbohydrates and potentially fats, but not enough protein. It's called
quashy or core. But where you have seen it are
those if you remember those old advertisements of this, like
(17:17):
quote unquote starving kids in Africa with the big bellies.
So that big belly is filled with a fluid leaking
from the liver because there's no protein in the body
to retain that fluid. It's called ascid's And that is
not starvation, not pure starvation. It is protein specific starvation.
So there is a disease syndrome associated with pure protein malnutrition.
(17:39):
I will say that you also die if you only
eat protein, and there are cases of this. You go
into keto acidosis if you don't have any sugar or
fat at some point, and this has been reported in
some very rare people who have been living like exclusively
on highly lean mind like rabbit meat. So there are
(18:02):
people living in the wilderness who like only eate rabbits
for thirty days or something, and you can actually die
of that as well.
Speaker 3 (18:07):
Don't you think at that point you'd also have scurvy?
Speaker 1 (18:10):
You would almost certainly have scurvy, But I think it
takes a bit longer.
Speaker 2 (18:13):
To get scurvy. Yeah, okay, we can do another episode
on scurvy.
Speaker 1 (18:18):
Yeah, a lot of our time, certainly, not a lot.
Speaker 2 (18:21):
Of people have it, but if you have it, it's
not good. Okay, So back to the product. Protein is
a thing that we need. We need a good solid
amount of because of these amino acids, particularly the nine
amino acids. Is any type of protein going to give
us the nine essential amino acids?
Speaker 1 (18:43):
Short answer is yes, we don't have to worry about
this too too much, And I think this can transit
provided you eat an adequate total amount of protein. Most
stuff you're going to get out there is comprised of
enough variation in amino acids that you'll cover your bases.
But this leads to the I think central question that
we're all asking ourselves. Certainly I am since I started
(19:05):
writing down what I'm actually eating from day to day,
which is, wait a second, how much protein am I
supposed to have? So Emily, I want to turn this
to you. How much protein does the government say we
need to have? And then I want to know how
much protein you have?
Speaker 2 (19:22):
Okay, So I will tell you that I hate this
question and I feel like it is the first question
people are like, how much protein.
Speaker 3 (19:29):
Should I have?
Speaker 2 (19:31):
And I think that that question is like fundamentally really
really flawed.
Speaker 3 (19:35):
So I will tell you what the government says.
Speaker 2 (19:36):
The government has a like recommended daily allowance, and it
is zero point eight grams per kilogram per day.
Speaker 3 (19:44):
So that's about a.
Speaker 2 (19:45):
Third of a gram of protein per pound. So if
you're a person who weighs like one hundred and eighty pounds,
that would say you should have about sixty five grams
of protein a day. That is actually not that much,
and most people in the U get that amount. So
I looked in preparation for this discussion, I looked at
the en Haines data, which is a national longitudinal representative study,
(20:10):
and they ask people about their diet and they calculate
their protein. And the average woman has studies getting about
seventy five grams of protein to day. The average man's
getting a little over one hundred. So that is actually
plenty of protein based on the government recommendations.
Speaker 1 (20:24):
And that recommendation, correct me if I'm wrong, is essentially
based on these calculations of like, if you fall below
this for a sustained period of time, you will actually
like get into worse health or potentially have malnutrition.
Speaker 2 (20:38):
Yeah, so this comes out of the recommended daily allowance,
which is a number that the government has designed in
order to tell basically an institutional like if you had
an institutional population, you know, you were like feeding people
at a jail, and you were controlling like how many
calories you would have available, and how much protein and
(21:00):
how many micronutrients they have, these numbers of which you know,
this is like this is one of them. And the
idea is that this is going to like this would
be enough for people to be healthy and like lead
a healthy institutional lifestyle.
Speaker 3 (21:18):
That's the basic idea.
Speaker 1 (21:19):
Let's say I want to do a little bit more
than be a healthy a healthy member of some institution.
Speaker 2 (21:25):
All right, let's sort of say like sixty five grams
if you're a person in one hundred and eight pounds,
like sixty five sixty grams of protein to day is
actually not that much. So a cup of Greek yogurt
has like twelve grams of protein. Chicken breast, a sort
of standard sized chicken brass, has probably thirty grams of protein.
So this is like, you know, you could get to
sixty grams of protein pretty easily, which is not surprising
(21:48):
that most people are there.
Speaker 3 (21:51):
The question then is like is that enough?
Speaker 2 (21:53):
And this is the discussion, like sort of out in
the world where people are telling you look or people influencers,
you know, fitness enthusiasts will say, you know, point a
grams per kilogram is nowhere near enough. A number that
often gets thrown around is like one gram per pound
of body weight. So that would mean for someone of
one hundred and eighty pounds, rather than take having sixty
(22:14):
five grams a day, you should have one hundred and
eighty grams a day. And that's a lot more than sixty. Obviously,
that is a ton ton of protein. Yeah, it's a
ton of protein.
Speaker 3 (22:24):
And I think the core question for people is, like,
is that something I need to be prioritizing in part
because like, that's work. Like to particularly to get.
Speaker 2 (22:32):
One hundred and eighty grams of protein while also not
consuming like four hundred billion calories is challenging. Right, When
people say get all this protein, they don't mean like
and also get an equivalently larger number of carbohydrates in fat.
They mean like, prioritize protein relative to those and that
takes effort.
Speaker 1 (22:51):
Right, So if we are pursuing that kind of goal,
and I tried it a little bit, I tried to
think to myself and it does take planning. It's like, okay, wait,
what am I going to have for lunch? And how
am I going to get all this protein in? And
you're looking for foods that are, you know, how per
calorie have a lot of protein in them. And one
rule I sort of saw that does work out fairly
(23:12):
nicely is that if you take the grams of protein
in a food and you multiply it by ten and
that's more than the calories in the food, then it's
like a high protein food. So for example, if you
know there's ten grams of protein in a one hundred
calorie portion, then that's a high protein food. And that
works out to about forty percent protein per calorie, which
(23:34):
is like that seems about right to me, But it's
actually quite hard to even all those protein bars and
stuff at costco like don't necessarily get to that level.
Speaker 3 (23:46):
Yeah, I think so, I think we should talk about
how to get to that level.
Speaker 2 (23:48):
But I think we should also we should start by
talking about, like what are the scenarios in which you
would want to get to a higher level of protein. So,
because I think again getting back like the question of
than asking what is the right amount of protein, I
think the first question people should say is like what
is their goal?
Speaker 1 (24:05):
What is your goal?
Speaker 3 (24:06):
And I think there's a few different goals people have.
Speaker 1 (24:08):
Let me give you my goal. I want to know
about building muscle. I want to I'm in my forties
and I'm looking to get a little.
Speaker 2 (24:17):
Bit mid mint to late forties, Perry, you.
Speaker 1 (24:21):
Know who's counting. I'm in my mental late forties and
I'm hitting the gym, and the guys there are I
will say, very into protein. So what's the evidence there
is protein supplementation good for muscle? It makes sense, right,
Protein blocks supplement is the building block of muscle. That's
what I learned in biology.
Speaker 2 (24:43):
This is the place where I think the evidence the
sort of most clear that protein is key to building muscle.
And if you are either a person in your mid
to late forties who is looking to build some muscle,
or and I think this is important if you're an
older person who is trying to maintain muscle mass. Hard
to build my muscle when you're you know, in your
sixties and seventies, but you can maintain muscle. It's really
(25:03):
important for like not falling down. And we have a
fair amount of good evidence, particularly in these older populations
that having a higher amount of protein relative to these
you know, recommendations. But having more protein can maintain muscle
mass and can improve people's health.
Speaker 3 (25:24):
But and this is I.
Speaker 2 (25:25):
Think like the most important thing. It is not just
eating the protein. You also have to exercise. Right, Like
we talk about the protein, like you eat the protein
and then it like magically turns into muscle.
Speaker 3 (25:37):
That's not how it works.
Speaker 2 (25:38):
You eat the protein and you do resistance training some
kind of exercise, and those together make more muscle. So
if you're gonna you perry, you are going to go
to the gym and stand there and watch the other
guys while you eat a protein bar. Nothing will happen
except you will just be a person who's eating a
protein bar.
Speaker 1 (25:55):
It's such a good point. And I will say that biologically,
when your body breaks down that protein into its constituent
amino acids, there are two pathways that those amino acids
can go down. One pathway is those amino acids get
incorporated into a new protein like a muscle fiber. The
other pathways that those amino acids gets further broken down
into sugar and you get calories out of it, and
(26:18):
your body is more than willing to get calories out
of anything you put into it if you're not using
it for some other purpose, So absolutely you got to
actually use it. Do you have any opinion about this,
like should I be doing protein supplementation before workout after workout?
Is that superstition?
Speaker 3 (26:35):
I have a lot of feelings about that.
Speaker 2 (26:38):
In general, it doesn't matter so most people, it actually
doesn't matter much in the data. This is a place
where we have pretty good data because it's actually very
easy to study people who are doing endurance sports or
any kind of sports, because they love to be studied,
and they're looking to optimize their protein intake in various
ways because they're lunatics. When you look at that those populations,
(27:02):
it doesn't matter what time of what. When you had
people tell you have to have your protein shape within
like thirty minutes after a workout is just not supported
by the evidence.
Speaker 3 (27:10):
You want to kind of have it within a day.
Speaker 2 (27:12):
But if we're thinking about over the course of a day,
it doesn't that whether you get all your protein, even
like all at once versus in multiple chunks, doesn't seem
to impact the performance.
Speaker 1 (27:24):
That's been something people have been worried about for a
long time. Was this idea that there's like protein overflow,
like if you took too much in at once, you
wouldn't use it and the excess wouldn't get used appropriately.
Not much evidence for that.
Speaker 2 (27:37):
Not much evidence for that, certainly over a course of
like a twenty four hour period.
Speaker 1 (27:41):
I want to move on from muscle because there's some
other interesting protein stuff out there, But before we do,
we should probably talk about the specialist of the amino acids,
which is leucine. So leucine is this amino acid that,
unlike all of its nineteen brethren that found in protein,
has a signaling effect in muscle. So in your body,
(28:04):
there are all sorts of signals that your body reads
to know how to grow and how to change, And
muscle has a signaling receptor for leucine. And it seems
like lucine may be the thing that muscle uses to
know that there's a lot of protein around, right, Like,
how does your muscle know it's safe to sort of
build more muscle? And there's some evidence that the signaling
(28:26):
molecule for muscle reading your nutritional status from a protein
perspective is this particularly meino acid, leucine because of that,
you see leucine supplement supplements out there. We've started to
see a few loucine supplement studies in terms of muscle
building with mixed results. But I wanted to bring it up.
(28:47):
There's not a good natural source of lucine beyond anything
else that has a lot of protein. So like chicken
breast has plenty of leucine in it, beans have lucine,
cottage she has lucine. Wherever you're getting your protein and
you're getting your lucine. But supplementation is always different, right
because now we're talking about something that's processed. You're getting
super physiologic doses, and we're starting to see that. Have
(29:09):
you had people coming to you talking to you about
lucine yet or is this still on the edge.
Speaker 2 (29:13):
I think this is still on the edge, and people
ask me a lot about protein in general.
Speaker 3 (29:16):
But even it's interesting.
Speaker 2 (29:18):
So I consume, as people will learn if they listen
to this podcast more. I consume a lot of endurance
sports content and even there you will see some discussions
of sort of lucine supplementation, but I think not as
much as you would get it. Like body, My guess
is in the body building space. This gets a lot
of discussion because the core there is muscle building.
Speaker 1 (29:41):
Yeah, yeah, so keep an eye out for that. We
might end up talking about lucine again in the future
if we ever get to wrap a micin and aging.
But speaking of aging the aging brain, so I'm willing
to concede that to build muscle you probably need to
have adequate prote ten intake. You probably need to have
(30:04):
are there recommended? Before we move on? Sorry, can you
give me a number like I is my one hundred
and fifty that I had that day? Is that a
good target for me? Clearly more than the sixty I
had when I just state mac and cheese.
Speaker 2 (30:16):
Yeah, I mean, I think a lot of a number
that a lot of people talk about is two grams
per kilogram or one point six grams per kilograms, So
that would put people in more like you know, somebody
like you, more like one.
Speaker 1 (30:28):
Hundred little less than a gram per pound.
Speaker 2 (30:30):
Little less than a graand per pound. A grad per
pound is a lot of protein. I think many of
these things go for one point six.
Speaker 1 (30:36):
All right, So I need to find some good ways
to get me today. Yeah, all right, So let's talk
about brains a lot of studies of protein supplementation have
focused on more older people, elderly people, particularly the frail elderly,
with some interesting results. One I pulled out of the
ether here a little bit was a trial called the
(30:57):
pro Muscle Trial smallest set sixty five frail elderly people
who were randomized to get supplementation with milk protein. Not
sure if milk protein is different than just way protein,
but it was described as milk protein thirty grams a
day in two doses versus just a placebo Emily, you'll
(31:18):
be happy to hear they both groups got resistance training.
Speaker 3 (31:21):
You have to do resistant Okay, of.
Speaker 1 (31:23):
Course, yes they they both got resistance training. But the
group randomized to the protein supplements at the end of
the trial, which was a couple months, had one point
three kilograms additional lean body mass and had a one
point improvement on the short physical performance battery, which is
sort of a variety of exercise based tests. So not
(31:45):
like amazing, but you know, a nice randomized trial we
like to see that seem to work. No particular difference
in their cognition or.
Speaker 2 (31:56):
Memory that would be consistent with the rest of my
reading of this, which is that the impacts on dementia
and so on are small or zero. I think what
sort of interesting and nuanced about that? Is my sense
from other pieces of data, is it staying like active
and engaged with the world is very good for your cognition.
(32:20):
So if consuming more protein and doing some resistance training
makes you able to walk around more and you know,
pick up your grandkids and not be bed ridden, that
could actually be good for your cognition, just because it
enables activities which are themselves good for cognition. So is
there a mechanistic effect through the protein affecting your brain.
Speaker 3 (32:39):
Maybe not. Is there a causal effect because it goes
through these other pathways.
Speaker 1 (32:43):
Maybe there is, I like the off target effects, the
knockout effects. Let's move on to the third scenario that
I like to think about when I'm thinking about protein intake,
which is can of helping lose weight. So protein I
have been told is good for satiety. It's a little
harder to break down, certainly than like a simple carbohydrate
(33:05):
which is going to give you that boost of energy
and then begone and then you're hungry five minutes later.
So I can make a biologic plausibility argument that proteins
will help you lose weight. Do you think they really
does A higher protein diet, I should say, really help
you lose weight, all else being equal, calorically.
Speaker 2 (33:22):
Speaking, look, maybe a little bit in the short term.
In a very core fact about diets is that they
mostly don't work in the long term. Most dietary changes
can cause people to lose some weight in the short term,
and then mostly they gain it back in the slightly
longer term. To the extent that protein causes you to
(33:46):
feel more full and makes it easier for you to
stick to the diet, then okay, that could make it
more effective, but this is not a game changer.
Speaker 1 (33:54):
I mean.
Speaker 2 (33:54):
And I also find this discussion at this point like
if people want to lose significt get amount of weight,
they should go on a GLP one And that's just
what it is.
Speaker 1 (34:06):
I tend to agree with you. I think all the
successful diets tend to be transient, and they all share
one thing in common, which is that it makes it
harder to eat food. And so you know, if you
look at Atkins or something, you know these keto diets,
like it just is harder. You have to think more
about what you eat. You have to plan a little
bit more, and I think high protein diets. My personal
(34:29):
experience as I've started to look around and like get
more protein into the food I eat is the same thing.
I'm like, oh no, I can't eat that. You know
that those chips are not you know, there's no protein
in there, and I need to find a source that
gets my protein. So I think whenever you make it
difficult for people to eat, yeah, protein chips would be
you know, but if you make it difficult for people
to eat, you're always going to lose some weight. I mean,
(34:51):
I will say there was a just to pull out
a randomized trial, you know, there is some evidence of
weight loss. There is a twenty ten study which randomized
and men with diabetes to a thirty five percent protein
diet to it versus a fifteen percent protein diet. They
were both calorie restricted. So that's that's another thing you
have to account for. Like, as you said, Emily, if
(35:12):
you eat more protein, but by eating more protein, you're
eating thirty percent more calories, You're you're definitely not going
to lose weight, right. But in this calorie equalized environment,
the men who randomized to the protein that had about
a three kilogram extra weight loss after four months. This
is not impressive in a world that has GLP ones,
(35:34):
I understand, but as we said, not everyone has access
to GLP ones. Everyone has access to protein.
Speaker 3 (35:39):
We hope agreed.
Speaker 2 (35:40):
I will say there is an addendum here in the
GLP one space, which is to the extent that people
are on a GLP one, you know, that makes you
eat less. And as we said at the top, protein continues.
Speaker 3 (35:52):
To be very important.
Speaker 2 (35:54):
And so to the extent that you are on a
GLP one and trying to lose weight and do.
Speaker 3 (35:59):
Not want to lose muscle mass, you.
Speaker 2 (36:02):
Do need to prioritize getting a larger share of your
calories from protein, because you basically want to keep your
protein more similar to where it was and drop other things.
And I think that can be a challenge for people
when they're sort of not hungry and they just kind
of don't want to eat anything. It's not just eating less,
it's changing the balances of food.
Speaker 1 (36:22):
This is what I want to hear from you as
we as we wrap this up. My wife has terminator
vision for food, Like she can look at a plate
of food and tell you, like, how many calories, how
many grams are fat? How many grams of protein? I
don't know if all women have this. I'm not sure
if it's built in.
Speaker 3 (36:38):
We developed it.
Speaker 2 (36:39):
We've developed it all women in our in our mid
to late forties. We developed this a long time ago,
and we're retaining that skilled ye accurating a bike.
Speaker 1 (36:46):
Like I will, I will take a package that has
the nutritional information and she will be able to do
it. It's very impressive. I cannot do that. I know that. Intellectually.
I'm like, oh, yeah, chicken, that's good. But let's say
I decide, you know what I'm going to go for it.
I'm going a gram per pound a lot of protein.
I don't think I can make it. What are your
tips for me? And maybe I'll make it even simpler?
(37:11):
Is there any way to do this short of me
buying in bulk some can of protein powder, whether it's
weigh powder or soy powder or you know, wheature, whatever
it is, and adding it to things and making shakes?
Or can I do this with food as it exists
in reality?
Speaker 3 (37:27):
So we term doesn't have a lot of protein, So don't.
Speaker 1 (37:30):
Vi weat gluten? Sorry weak gluten?
Speaker 3 (37:33):
Oh good lord? Okay?
Speaker 2 (37:34):
So uh So I will say I think for most people,
if you are attempting to get something like a gram
per pound of body weight, which again is a lot
even for a pretty small person, is a lot, you
will need to use some kind of protein powder, something
(37:57):
some kind of thoughtful of pro coach, which probably involves
supplementation with not real food. You know, think about like
a protein shake, you know why. Protein shake probably has
can you know, can have twenty five grams of protein.
That's like a whole chicken breast pretty much. And it's
just hard for people to consume enough whole foods to
(38:18):
get that kind of protein without also adding a lot
of fat and carbohydrates. So I will say, you asked
me at the top, how much protein do you eat
in a day? I do eat about a gram of
protein per pound of body weights. That's about one hundred
and thirty ish grams of protein a day. And the
only way that I can achieve that is by consuming
like a large protein shake in the morning.
Speaker 1 (38:39):
And what is the protein? Is it way protein?
Speaker 2 (38:41):
Typically that it's just way breakenth yeah, just way protein.
All right, all right, So now here's my question for you.
We have revealed that I'm a crazy person who drinks,
who eat, consumes a lot of protein, and I should
say I just I want to say. The reason that
I consume a lot of protein, getting back to these
questions of like why are you doing this, is that
I take myself infinitely too seriously with sports. I'm like
(39:02):
a pretend elite athlete, a person who pretends to be
an athlete, and I so I run a lot and
I consume a lot of protein in service of that.
Speaker 3 (39:11):
So that is my that is my reasoning.
Speaker 1 (39:13):
So not for everyone, but not for people.
Speaker 2 (39:16):
Like you people crazy people. So here's my question. Can
you have too much protein? And what would happen?
Speaker 1 (39:24):
So yes, as a medical doctor, yes you can. So
a couple of things.
Speaker 3 (39:30):
You're a kidney doctor, I'm a kidney doctor, specifically good.
Speaker 1 (39:34):
Particular yes, yes, no, this is this is certainly right
up my alley. So so yeah, I mean, first of all,
if you only had protein to the exclusion of all
other macro nutrients, you die. We talked about this, very
difficult to do unless you're only eating rabbit meat, so
I'm not too worried about that. But from a kidney standpoint,
the data is quite compelling that more protein intake puts
(39:56):
more stress on the kidneys. And I'm pausing on the
word stress, because what exactly do I mean by that.
We measure kidneys filter the blood, and we can measure
the rate at which they filter the blood in milli
liters per minute, and for a healthy person it's about
one hundred millimeters per minute, which means that you're cycling
through your entire blood volume dozens and dozens of times
(40:19):
a day with your kidneys cleaning that, which is great.
Acute protein intake increases that filtration rate so from one
hundred to one hundred and ten one hundred and twenty
mili liters per minute, and you might think great, you know,
like that's more filtration now. Of course, the reason your
kidneys are doing that is because, unlike carbohydrates and fat,
(40:40):
proteins are metabolized into ammonia, and ammonia needs to be excreted.
It's excreted as this thing called urea, which is where
urine gets its name. But urea is the way that
urine excretes ammonia. You have to increase filtration to get
rid of the ammonia load. There is data in people
with kidney disease that low protein diets protect the kidneys
(41:03):
in the long term. That's been well established. In fact,
up until about ten years ago, we would routinely recommend
people with kidney disease to decrease their protein intake for
just this reason. Nowadays I don't do that, in part
because of what we've talked about. I'm also worried about
their muscle mass and their health and their ability to
(41:25):
move around and get exercise, and I don't like telling
people to restrict, but I certainly don't tell my patients
with kidney disease to like supplement protein. And the reason
it seems that your kidneys are better off when they're
not stressed like this, when they're not forced to increase filtration,
is that there's a finite amount of tread on the tire,
(41:47):
and at least for people with underlying kidney disease, forcing
them to run at one hundred and ten percent one
hundred and twenty percent capacity just stresses them out more
and you lose kidney function faster. What I don't know
if is that's true for people without any kidney disease.
We don't have long term data a very high protein
(42:07):
intake to suggest if that alone in the absence of
other diseases is going to affect kidney function, but it
clearly does in people with underlying kidney disease.
Speaker 2 (42:15):
I think the other piece of the we will never
know the answer to your last question, I think because
the kind of people who are consuming very high amounts
of protein are also very different, correct, mostly healthier, but
just very different in other ways. So we would never
really be able to compare you know, the people who
having two and a half grams of protein per kilog
like these very high levels to lower levels, because you're
(42:38):
just going to.
Speaker 3 (42:38):
Find they're different in all kinds of other all kinds
of other ways.
Speaker 1 (42:40):
Yeah, there's a very hypothetical other risk which I will
just say that protein does have signaling effects, including that
lucine thing that signals muscles to grow. In the context
of muscle, we like growth, but there are other parts
of the body that we don't want to grow. And
so yourself in your body are kind of constantly under
(43:02):
balanced signals saying grow, divide like fill in this space,
you got to cut like heel at that kind of stuff.
Muscles get bigger, you know, fat cells grow like all
those kind of things, and signals that say no no, no,
stay quiet, stay where you are. We know when those
signals get out of hand and excessive growth signaling occurs
that that is a step towards cancer development and lucine.
(43:25):
This particular amino acid stimulates a molecule called m tour,
a million target of wrapamycin, which is a known cancer
promoting chemical in the blood. Now it also promotes muscle growth.
So and there are usually there are many steps to
(43:46):
getting cancer beyond just like, oh, your level of M
tour might be a little bit too high. So I'm
not as worried about this as I am about kidney
function and very high protein intake. But you know, for
interest of completeness, we should say that growth in and
of itself is not universally a good thing. Okay, that
is a ton of information about protein. Let's let's wrap
this up, Emily, protein smash or pass?
Speaker 3 (44:12):
I think this question is unfair.
Speaker 2 (44:13):
You need protein for life, so in that sense, I
would say I'm going to smash it as an essential
element of not being did I will say if the
if the question is do I smash getting even more
protein than you're getting now, I think.
Speaker 3 (44:30):
For most people I'm a pass on that. How about you.
Speaker 1 (44:35):
I'm I think a soft smash on this question of
getting extra protein. You know, I think probably we should
be more cognizant of the protein we take in. If
we can get some extra protein, especially if we're replacing
carbs in our diet, I'm down for that certainly. I
think my one concern actually is that we really should
(44:56):
be getting as much protein as possible from plant based
sources so we don't tank our fiber intake, which is
something we'll talk about in future episodes, especially when we
look at the arising incidents of colon cancer. So cautious smash,
but you don't have to go crazy about it.
Speaker 2 (45:11):
I feel like you're putting too many caveats into your smashes.
We have to be a committed Perry in future episodes.
Commit to smash your pass. There's a soft smash. All right, Fine,
that's it for protein your mail bag Question of the
week after the Break.
Speaker 4 (45:33):
Hi, Emile and Perry. My name is Natalie and I'm
from Boston. Have been listening to the podcast and I
heard you say that there's a lack of evidence on
the efficacy of shockwave therapy. I've received this treatment a
couple of times. For instances of tendonosis, and I was
really pleasantly surprised. Of course, I'm willing to accept the
possibility of the placebo effect, but my curse research of
(45:53):
the literature did turn up a few studies that seem
to support shockwave treatment. I would love to hear your
thoughts on this. Thank you so much. Hi.
Speaker 3 (46:03):
Shockwave therapy.
Speaker 2 (46:04):
Yes, so, I have spent a lot of personal time, Perry,
looking into this because I had a hamstring injury, hamstring tendinopathy,
and I was told that shockwave therapy would help for
those of you who are not you know, deep in
the well of this activity. What this involves, at least
in the sports context, is somebody taking a probe and
(46:26):
some gel and delivering like acoustic waves into your tissue.
It's quite uncomfortable, and the idea is that it like
boosts your cell metabolism and generates better repair. I will
say I did look into the data before I did this,
and there is some reasonable randomized data suggesting that this
(46:48):
improves healing speed in some tendonopathy related injuries, things like
achilles tennis elbow rotator, actually your rotator cuff, Perry, it
might help with that and I will say really helped
with my hamstring, although it's very painful. Like there's a
person doing this and they're like, what's your pain level.
Speaker 3 (47:08):
I was like, oh, it's like a four.
Speaker 2 (47:09):
He's like great, we're going for a seven, and then
they just like turn it up until you're like, ah.
Speaker 1 (47:15):
Just compared to that, my hamstring feels great.
Speaker 2 (47:18):
Exactly afterwards, you're like, oh, thank god it's over. So
a little bit of positive evidence on this.
Speaker 1 (47:24):
Yeah, we use it for kidney stones. Actually, I mean
this is sort of different, but you know, for small
enough kidney stones, you can send the shock weaves in
and they kind of break up like an opera singer
shattering a glass with her voice, and then you pass
the little pieces out, which is I guess better than
going up and retrieving them yourselves. Do you want to
know a little interesting physics?
Speaker 3 (47:45):
Yes, always so.
Speaker 1 (47:48):
An ellipse has two fox si. That's like how you
define the ellipse, Like two focuses two points inside the ellipse,
and every point along the outer edge of the ellipse
is equidistant from like the sum to the distance between
those focia is constant. That's what defines an ellipse. Okay, wait,
any time anything that goes through one focus bounces off
(48:08):
the edge of the ellipse and will go through the
other focus. And so for extra corporeal shockwave lithotripsy, they
put the sound emitting device, the ultrasound device, at one
focus of the ellipse, and then they curve the ellipse
that it's in. It's like a half ellipse, a shell,
so that's that sound bounces off and all of it
(48:30):
gets focused into the other focus of the ellipse, which
is somewhere inside your body. Isn't that kind of neat?
Speaker 2 (48:36):
That is incredibly interesting and physics is very neat, I
think no. Okay, So one question I think maybe people
have about the shockwave therapy is like, is this just
place ebo? Because of course we know the placebo effect
is one of the best effects, and it's hard to
know if something is real or sham. But actually, in
(48:57):
a lot of these studies of shockwave therapy they do
placebo sham shockwave therapy on people. I'm not really sure
how that would be involved and is it less painful?
So we always have to be careful about placibo effects.
On the other hand, my hamstring feels much better, So
I guess I don't care.
Speaker 3 (49:13):
Why is my fundamental answer? All right, that's it for
this week.
Speaker 2 (49:17):
Join us next week when we'll ask what's the deal
with continuous glucose monitors? Wellness Actually is produced in association
with iHeartMedia.
Speaker 3 (49:27):
Our senior producer is Tamar Avishai.
Speaker 2 (49:29):
Our executive producer at iHeart is Jennifer Bassett. Our theme
music is by Eric Deutsch, and our content is for
educational purposes only.
Speaker 1 (49:38):
If you like the show, help other people find us,
leave a rating and review on Apple Podcasts or your
podcatcher of choice, and help us spread the word about
the show. You can follow us on Instagram at Wellness
Actually pod and don't forget We want to hear from you.
Head over to Wellness Actually dot fm and leave us
a question for our mailbag or suggest a topic for
(49:58):
a future show.
Speaker 3 (49:59):
We'll let the influencers have the last word.
Speaker 5 (50:02):
This is why I'm jacked and you're not. It's because
I eat meals like this round beef and whole eggs,
pure protein and healthy fats, zero carbohydrates. This is what
I wish fat people understood if they just cut out
carbohydrates for two weeks. I'm talking zero grams to twenty
(50:22):
grams of carbs per day. They would lose ten pounds instantly.
Speaker 1 (50:27):
It's that easy.
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