Dr Rupy: The recommended guidelines for protein are sufficient for general health and wellbeing. No, I don't believe that. I think it should be at a minimum 50% higher. Protein is largely about muscle health. No. If I eat more protein, will I automatically become healthier? No, not necessarily. Chicken, meat and fish are the best sources of protein. This really depends on how you define the best sources, but no, not necessarily. Beans and lentils are good sources of protein. I actually don't think so, not on their own. I can boost my protein intake with powders or convenient bars. Yes, you can, but I wouldn't suggest you do it that way.
Dr Rupy: In today's episode, I'm talking all about protein, why it matters, how much you really need, and how it could be the missing piece in your approach to health. This is also based on a number of questions that we've had about the book Healthy High Protein as well. So today, it's a solo episode and I'm going to dive into why protein is essential for everything from muscle maintenance to hormone production, just a bit of a whistle stop tour because I know I've spoken about that before. But we're also going to talk about the link between increased protein intake and menopausal health, how eating more protein can prevent unwanted weight gain, why I believe getting enough protein and fibre at breakfast is one of the smartest moves you can make for long-term health and longevity. The signs and symptoms of low protein intake. This is something that I've been asked about a lot on radio shows, how to spot them before they actually affect your energy, immunity or mood in a big way. Who is at most risk of under-consuming protein and how you can make simple, sustainable changes to ensure that you're getting enough. And also, what is the best quality protein source? Quality proteins, this is something that comes up a lot, which is best, plant versus animal. I'll talk about the different scoring systems and my two cents on how to approach that as well. Whether you're navigating menopause, trying to improve energy levels, or just want to eat in a way that supports your body as it ages, this episode is going to be packed with practical tips and grounded in science. You can also grab the new book, Healthy High Protein, that's been a Sunday Times bestseller for three weeks in a row. I'm super proud of this book. I know you will love it. I've got so many good comments and great feedback about it so far. People are using it, they're feeling stronger and healthier. Chris Evans keeps on going on about it. Loads of my friends absolutely love it as well. I'm getting lots of messages of people making the Doctor's Kitchen daily bread, one of my favourite recipes. So if you don't have a copy, make sure you go check it out from all good bookstores and the link will be in the podcast caption as well.
Dr Rupy: Alright, so we've had loads of questions about protein ever since I published my book, Healthy High Protein, and on the back of a number of different podcasts that we've done. So to summarise, proteins are complex biomolecules essential for nearly all biological processes, right? They're composed of around 20 amino acid chains and they're folded into different structures depending on their purpose. I've used the analogy of Lego before to describe protein and I think it works really well. Like, when you were a kid, you used your Lego and you could build something like a small car, but you could also build something incredible, like a huge cathedral or a spaceship, as long as you had enough pieces. And even if you only had 20 different types, you could build these vastly different structures. Well, Lego are the building blocks in the world of toys. In the same way, proteins are the building blocks in the world of biological materials. So depending on the sequence of amino acids, the building blocks of proteins, the size of the entire structure, how the proteins are folded into a 3D shape, and even the assembly of these units of proteins, these will all determine the function of the protein. And there are vastly different types of functions that you can have with proteins in the body. Enzymes, for example, these are things like amylase or DNA polymerase, they catalyse biochemical reactions. They're used in digestion and DNA replication. Again, so many different types of proteins that are enzymes. They can provide obviously structural support, so they provide rigidity and elasticity, things like collagen, for example, these are made out of proteins. They can have a transport role. So haemoglobin, as an example, carries oxygen around the body. Even lipoproteins, the clue's in the name here, lipoproteins carry things like cholesterol around the body. These are made out of proteins. Immune health. So whilst we think of our immune cells as antibodies and they macrophages and they they neutralize pathogens, these are proteins. Antibodies are the structures that bind to antigens and they are critical parts of your immune system made out of proteins. Proteins are also involved in signalling, so they transmit cellular messages, things like insulin, for example, that regulates blood sugar, it's a hormone, or growth hormones, for example, these are all proteins. And of course, movement, so enabling muscle contraction and cellular motility, these are things like actin and myosin, these are all made out of proteins. So as you can imagine, protein are key to orchestrating everything from life's molecular processes, from transport and chemical processes with enzymes. It's not all about how rippled your abs and biceps are in the mirror, even though I know that is very important to many of you. So when you appreciate the varied functions of protein in the body, you begin to understand this pretty shocking realisation that only around 25% of the protein you eat is actually used for muscle building and maintenance. The rest of the proteins from your diet are broken down and used for this massive variety of other uses, repairing cells, building connective tissue, manufacturing immune cells, etc. In fact, we can't consume enough protein in a day for our body requirements, which is why whether you're in your 20s or 60s, your body actually churns through around 300 grams of protein every single day. That's the equivalent to around a kilo of chicken breast daily. Obviously, no one is consuming that much protein every single day, and it's for this reason that over evolution, we've developed mechanisms to ensure that we get the proteins we require for all these important processes. Our intelligent bodies have developed ways to break down and recycle proteins in the absence of new proteins being available. Your protein turnover is so high, you actually replenish every protein in your body each year four times over. This statement actually contains a little bit of hyperbole, I admit. When I say replenish proteins, I'm referring to this process of protein turnover. This is the continuous process of breaking down and synthesising new proteins in the body. And like I mentioned before, the body is constantly renewing proteins all over the place, but the rate of turnover varies widely depending on the type of protein and the tissue involved. So for example, fast turnover proteins are found in places like the liver or digestive enzymes, for example. These can be replaced within hours to days. It's very, very fast. You've also got moderate turnover proteins. These are things like muscle proteins. These have a slower turnover rate than our fast turnover, and these can take anywhere between a week to a few weeks to renew. And then you've got slow turnover proteins. These are typically structural proteins like collagen found in skin, bones and connective tissue, and even protein found in the lens of the eye. These can last years or even a lifetime without ever being replaced. So there's a lot of nuance to this conversation and I've tried to summarise as much as you need to know about the different types of proteins, how they're utilised, the varied processes, the varied use cases for them, as well as how much protein we actually require and churn through every single day. By now, you should have an understanding of why I'm just so passionate about this subject, why protein is not just for bodybuilding and muscles and why it's exceptionally important to consume enough protein every single day. We don't have a storage mechanism for protein and it's really, really important that people understand the link between having enough protein every single day and healthy ageing, preventing things like frailty that we'll get into in a second, and how it's not necessarily reliant on consuming more meat and fish. We can actually get enough proteins from a variety of different sources that also have extra benefits to our health as well. I want to zoom in on protein and menopause. Protein intake becomes critically important during the time of the menopause because of the biological changes that increase the risks of muscle loss, weight gain and bone fragility. There are lots of other things going on during menopause and post-menopause because we know that there are higher risks of type two diabetes, dementia, cardiovascular disease. But I just want to zoom in on these three areas first because I think they're all related, particularly the first one, which is combating muscle loss. So this decline in oestrogen accelerates age-related muscle loss with studies showing up to 32% muscle reduction in late post-menopause. Muscles are not just about aesthetics and strength. I think this is a very important point to take home for anyone. Your muscles also serve as an important store of sugar. I mean, your muscles are organs for starters, but they are also an important store of sugar. The less muscle you have, the higher the risk of metabolic health issues like type two diabetes because more sugar has to be stored as fat. That's just one element of what muscles are doing for us. There's also a suggestion that during perimenopause, hormonal changes like the reduced oestrogen and testosterone lead to increased tissue protein breakdown and a higher appetite for protein. If you don't meet this higher appetite for protein, it can result in overeating other macronutrients because your body is seeking out proteins. And that can contribute to weight gain. Now, you might feel that you eat the same amount of food and your metabolism has, quote unquote, slowed during the menopause. But the evidence suggests that it's unlikely to be metabolism related and more so that we tend to naturally consume more because of this higher appetite of protein that is otherwise unmet. The second thing is that higher protein is associated with lower fat mass. We're going to talk about this in a little bit more detail later, but I just want to make that statement for anyone who is going through the menopause or post-menopause. High protein, less fat mass. This is something that is really, really important. The third thing is bone density. Protein works synergistically, i.e. in cahoots, with calcium and vitamin D to maintain bone density. This could be because protein enhances calcium uptake and it stimulates something called growth hormone, also known as IGF-1, and this helps lay down bone cells, creating stronger bones that are less likely to fracture on impact. An important caveat is that all of the above that I've just mentioned, reduction in fat mass, reduction in muscle loss, bone density, needs to be combined with exercise. Protein alone is not going to solve our issues. It's the synergism between exercise, particularly resistance training, that we're looking for with higher consumption of protein. Okay. So going back to the point I made about weight loss and reduction in fat mass. How can dietary protein support weight loss and weight maintenance? Well, there is something called the protein leverage hypothesis that states if your protein needs at a meal are unmet, the body drives overconsumption of calories. It's not necessarily overconsumption, it just means that the hunger signal is constantly turned on until your protein target is reached. So, for example, if you're having croissants at breakfast or cereal or something that's quite refined, some orange juice, you might reasonably have a full meal. It might have a little bit of protein in, fine. But you still might be hungry come mid-morning. And the reason why, at least according to the protein leverage hypothesis, is because you haven't met your protein requirement. And so that hunger signal that's sent to your brain is just continuously switched on. When you have more protein and fibre at breakfast, you dampen down those incretin hormones that lead to that signal being switched on or continued to be switched on. It dampens down and so you reduce your cravings and you naturally put yourself into a calorie balance. This is the aim of what we're trying to do here. So there is an interplay between protein and fibre and satiety hormones. Protein almost acts like your body's built-in hunger manager, helping release hormones like CCK and GLP-1. Yes, you've probably heard of GLP-1 agonists because of Ozempic, semaglutide, etc. Lots of different medications out there that give you supraphysiological doses of GLP-1, but we naturally produce these hormones that signal to our brain that we don't need to consume any more food as well. It also delays something called gastric emptying. This keeps food in your stomach for longer, which again can switch on those satiety signals to signal to your brain and body that you've had enough food as well. Additionally, there is something called the thermic effect of food. Essentially, some of the calories in the food you eat are used to digest, absorb and metabolise and store the remaining food, and some are burned off as heat. When you consume protein, around 20 to 30% of those calories in the protein themselves is actually used for this purpose, whereas for carbohydrates, it's less energy intensive to do those things. It's around 5 to 10% of the calories. And for fat, it's even less so, it's around 1 to 3%. So whilst I'm not a proponent of calorie counting, as I think it can lead to an unhealthy relationship with food and it can undermine food quality, which I think is something that we need to focus on, when it comes to weight loss, scientifically speaking, the number of calories you consume each day is the determining factor of whether you lose weight or not. And so by eating more whole food sources of protein, you're naturally putting yourself into this calorie deficit by the thermic effect of food and the satiety signals, etc, without having to rigidly count calories for the reasons I've already mentioned. You reduce hunger, you've increased your utilisation of calories from protein. It's pretty, I would say that's a much healthier relationship to have with food. I've never counted calories, I've never felt the need to. I think counting calories can work for certain people, athletes, people who are really interested in body composition and want to get to unhealthy levels of leanness and low fat percentages for whatever reason. But if we're really focused on health, which is what I'm all about, I really don't think calorie counting is a great means in which to achieve that. I've actually talked about calorie counting in previous podcasts and different videos, but in summary, like I said, I'd only recommend calorie counting if you're an athlete or bodybuilder or you have some other sort of unhealthy obsession with getting as chiselled as you can in the mirror as well. After fasting, which is something that we all do overnight, breakfast protein and breakfast fibre is essential because your body is also in what's called a catabolic state. So you've been breaking down proteins overnight to maintain these essential functions. And so you want to be replenishing those amino acids as soon as possible. A high protein breakfast, which for most people, if you do the protein calculator, you'll recognise exactly how much this is for you, but for most people, it's around 25 to 30 grams. And this provides those amino acids that you need to kickstart proteins being remade again. It will help maintain your muscle mass and strength, and it's crucial for metabolism, mobility and healthy ageing as well. The other thing is that spreading protein over the day appears to be better for muscle health as well. There was actually a big study out of the Quebec New Age project that tracked 1,700 older adults for three years looking at how spreading protein across meals impacted things like strength and mobility. And they found that people who ate a balanced amount of protein at breakfast, lunch and dinner, so at every meal they had good sources of protein, they had much better muscle strength than those who loaded up on protein at just one meal, like dinner as well. So there does appear to be some association with spreading your protein out over the day rather than just in concentrated meals. And just from a convenience and practical standpoint, you're just more likely to hit your daily protein goals by starting at breakfast compared to saving it all for singular meals, particularly if you're eating a plant-based diet, which is where it's a little bit more difficult to get your total protein requirements over 24 hours. And that's also backed by research. There was one study that looked at nearly 500 older adults and they found that eating more protein at breakfast and lunch helped them hit higher daily protein goals as well. So this is why I'm a big fan of starting your day right, getting enough protein and fibre in as soon as possible. In the same way, you want to be doing your bed in the first thing in the morning, you want to make sure that you're setting yourself up for a great day and you're not chasing your tail at the end of the day as well. You can tell I'm inspired by lots of military people online who who have these wonderful habits that I could learn a lot from myself. How can you tell if you're not getting enough protein? This is a common question that we get. Um, and I think outside of malabsorptive states because of gut health issues, extreme starvation or famine, which are often accompanied by physical signs of muscle wasting, if you're generally fit and well and you're worried about a mild protein deficiency or just not hitting your numbers, there are three questions to ask yourself, I think. Number one is, how do you feel? Lean into your intuition. If you're constantly hungry, if you're snacking all day or struggling to feel satisfied, this could be a symptom. If you've got low energy levels, granted, there are many reasons why people feel tired a lot or all the time or experiencing energy crashes, but it's one of those things that points in the direction potentially of not getting enough protein. If you're losing muscle, if you're noticing a loss of strength or muscle mass, especially as you age, this is a big sign that you're potentially not meeting your protein needs or your exercise needs to shift more towards resistance training and the volume of that as well. Um, and if you have slow recovery after exercise, this is actually something that I recognised in myself, soreness, fatigue that lingers. This also might be a sign that you're not getting enough protein or just generally not eating enough. So the first thing I would say, yeah, definitely lean into how you feel, lean into that intuition. The second thing is simply looking at your plate. Are you getting at least two different sources of good quality protein at every meal? Fish, eggs, tofu, tempeh, Greek yoghurt, beans, lentils are plant-based partners, nuts and seeds. We've got lots of materials on the doctorskitchen.com website for protein cheat sheets and stuff that you can use to guesstimate how much protein you might be having at each meal. Um, these are all things that you can look at and determine whether you're getting enough protein at every meal. If you're if your meals are carb heavy or vegetable heavy, plain toast, pasta, salads, greens, cereals, soups, or just vegetables, you're potentially missing out. I'd always want people to be able to recognise good core sources of protein in their diet. And number three, do you actually know how much protein you need to consume? I think, whilst I'm not a fan of calorie counting, it's a good idea to calculate your protein requirements and have a rough goal in mind. I don't want people to be rigidly measuring out their plates to determine exactly gram for gram how much protein they should be consuming. We want to be able to have a general idea of how much protein we're having in a 24-hour period. And I've got some materials that I'll share a little bit later to help you determine that as well.
Dr Rupy: So how much do I actually suggest you consume? I've sort of been dancing around this question. Well, I wrote Healthy High Protein, the cookbook, to stress the importance of eating high protein meals, a minimum of 1.2 grams of protein per kilogram of ideal body weight per day, but while also supporting your gut and inflammation levels as well, reducing them. The reason why I wrote this is because there's a lot of interest in the academic nutrition world around protein and how important this is in older age, post-menopausal phases, and also just healthier ageing, preventing things like sarcopenia that we'll talk about a little bit later. But in the public sphere, high protein is very much in the domain of bodybuilding and the fitness community, which has a focus on macronutrient balance, calorie counting, measuring how much there is in their plate and in different Tupperwares and all that kind of stuff. Protein is just so much more than just muscles and aesthetics, as you've already learned. And this is why I wanted to sort of break people's frame away from just thinking about protein and muscles to protein and health, protein and immune health, protein and hormones, etc. There is a bit of a pushback against my opinion on whether we need to be consuming more protein at a population level. So I thought I'd share some background with you on this. So in the UK, the average daily protein intake does, I want to just underline that, does exceed the recommended levels. So according to the British Nutrition Foundation, adults aged 19 to 64 consume on average 76 grams of protein per day, whilst those aged over 65 have an average of 67 grams per day. So these figures surpass the current reference nutrient intake of 0.8 grams of protein per kilogram of body weight per day, which equates to approximately 56 grams for an average man, whatever that is, and 45 grams for an average female. However, when you apply the minimum amount of protein that I believe and many other protein researchers believe and many other people in the nutrition world believe we should be consuming, which is 1.2 grams of protein per ideal body weight of per kilogram of ideal body weight, it's clear that some of us, many of us, could do with more because at 76 grams of protein on average, many of us would actually require a little bit of a bump. And in some cases, as we'll discuss, a lot more as well. And just to caveat this section on how much protein we need to be consuming, I want to emphasize that I don't want people to be rigid with their protein goals. I've said this before, but I think it it just it warrants just underlining this point. I want you to be able to guesstimate rather than weigh or measure. Your body is like this incredible balancing machine. A few grams of protein extra or less here is not going to make a huge difference. Over time, the big goal is to ensure you're getting enough. And if you are more cognisant of how much protein you're getting every single day, you will make that up. So I'm not worried about the one or two or three grams here and there, that's totally fine. I'm not even worried about the days where you don't have enough protein by a meal or so. I'm more concerned about the amount of protein over weeks and months. And to be a good guesstimator, I believe, is to understand roughly the protein amounts on your plate by just looking at ingredients and estimating these amounts. So in my book, which I'll I'll share with you this this double page spread that I'm going to pull up for those of of you watching this on YouTube. So if you're not subscribed to YouTube or you don't have the book, you want to go over there at the moment or just grab the book. Um, each ingredient is laid out in cooked amounts. So for example, cooked lentils or cooked fish, and there's a range of the total protein it contains. The reason why there's a range is because depending on which nutrition database you look at, whether it's a UK database or an American database or a European database, there are really big differences in how they've estimated the protein amount. So this is why we almost have to be a guesstimator because no one knows the exact answer with the exception of something refined like a whey protein. If you're looking at cooked chicken, cooked beans, cooked tempeh, there's always going to be a range. So using this double page spread, I want you to be able to roughly estimate your protein consumption in the same way you can roughly estimate how much water you've drunk today, depending and deciding whether you actually need to have a little bit more or less. I probably need a little bit more, which is why I'm going to take a sip. But I think everyone can reasonably understand the analogy of, okay, if I understand how much protein there is in lentils and nuts and and beef and chicken and fish, I can understand how much protein I've had at breakfast, lunch, dinner for the day and whether I need to boost it up a bit more in the evening or whether I need to ensure that I'm getting enough protein at breakfast, which I think is where most people are missing out. So that that double page spread will be shown just here. I'm probably speaking over it at the moment, and I think that's super, super helpful for for many people. You'll be able to find some resources as well on the doctorskitchen.com website.
Dr Rupy: Particular groups of people should be aware of their protein intake even more so, okay? So these are the folks that I think are at most risk of low protein. Women who generally have lower protein intake than men, possibly linked to low energy needs and perhaps less appetite, definitely I would say you need to know how much protein you should be you should be eating and how much you should be eating as well. Older adults, so over the age of 50, up to 50% of older adults do not even meet the minimum daily requirements at 0.8 grams, let alone what is actually optimal for staying strong. We had a great conversation recently on the podcast with Professor Lee Breen about the amount of protein older adults should be consuming as well as the different types of exercises they should be doing as well. So this is definitely something that older adults need to be aware of. Those on calorie restricted diets. Now, dieting in general often means cutting everything out, including protein, which can lead to losing muscle instead of fat, which is definitely not the healthy way of losing weight. But more so, and this is something I'm seeing obviously a lot more commonly, are those on appetite suppressant drugs like GLP-1 agonists. These people 100% should be on a lifestyle program to combat the unfortunate side effect of muscle wasting because of lack of protein intake because they just physically do not have the appetite to um to encourage that and also weight training, resistance training to ensure that their muscles are stimulated to preserve that muscle mass as well. So definitely a group of of people that are at risk of low protein. And I hate to say it, but plant-based eaters, vegetarian and vegan meals often rely on single sources of protein, like a handful of lentils or beans, and it's just not enough to rely on legumes alone to meet your daily needs. You need either a higher dose, a bigger portion, or more variety, or really leaning into high quality plant-based proteins like edamame, tofu, tempeh. These are ones that come to mind immediately, as well as some novel nuts and seeds, things like shelled hemp seeds and peanuts and almonds. These are good sources of protein, but you need to be consuming enough of those as well. Remember, I'm saying all this because I don't think it's just about surviving and preventing deficiency. We all want to thrive. And whilst the current guidelines are enough to prevent severe malnutrition and deficiency, I think we owe it to ourselves to want the best for us and to preserve our health as much as we can as we age as well. And I firmly believe that increasing protein is just one way, just one way, not the way, but one way in which we can improve our health, particularly as we get older and we lose muscle mass as a general consequence of ageing. In fact, muscle mass peaks at anywhere between 20 to 30, depending on your exercise regime, your nutrition, etc. And you lose on average around 10% of muscle mass every decade. You also lose muscle strength on average around 4% each decade. This isn't to say that you can't slow this down or even build muscle in your older years, but it's certainly working against the natural order of things and against what is the average as well. And as an A&E doctor, our shifts are dominated by falls, frailty. It's a huge cause of morbidity and mortality that doesn't get enough attention, and protein coupled with exercise is something that can actually prevent this. And it's something that we need to be prioritising as early as possible. And general practitioners need to get onto it as well as community dietitians and community nurses as well. Another thing to bear in mind is that your body can't store protein. I've mentioned this a little bit earlier, but you need to be able to consume sufficient amounts of protein every single day. And if you under-consume protein over time, your body will start to break down its own proteins and your major source of protein stores are going to be your muscles. This is referred to as lean mass. Uh, and your muscles are a great source of amino acids, but you don't want to be pulling protein out of your muscles and break it down into these fundamental amino acids that are required for all those vital functions. This is the metabolic equivalent of dipping into your pension savings to pay the weekly bills. You you want to be preserving that muscle mass because that is your pension plan. That is your insurance for healthy older age as well. This is not a good idea for your financial future if you're dipping into your pension to pay for the weekly bills. In the same way, it's not a good idea for your health and longevity as well. This brings me on nicely to this idea of um sarcopenia. Sarcopenia is now considered a muscle disease. This is something that's relatively recent over the last 10 years. And the idea of sarcopenia as a primary muscle disease is rooted in this understanding that it involves adverse muscle changes that accumulate throughout life and can occur not only in older adults, actually, but also earlier in life. We're actually seeing that the prevalence of sarcopenia among younger people is rising, particularly as it's related to the inflammatory obesity state that a lot of us find ourselves in. So the the prevalence of sarcopenia among adults over 50 varies, but most studies report rates of around one in 10 over the age of 50. One in 10. That's quite a lot. But this jumps to one in four if you're over 50 and you have type two diabetes. So it speaks to this potential mechanism of why muscle wasting exists. And it increases significantly to around one in three in anyone who is over the age of 70. So if we have loved ones that have type two diabetes and are over the age of 50, it's likely, well, not likely, but there is a high chance that they have sarcopenia. And if we have any loved ones that are over the age of 70, regardless of their premorbid state, if they have any chronic conditions, there's a 30% or so chance that they have sarcopenia as well. How do we actually recognise this? Well, it's characterized principally by low muscle strength, but also size and function are used to diagnose it as well. We do things like grip strength that your GP can do, but also your community nurses can do, and gate analysis. These are part of the diagnostic process. Primary sarcopenia is age-related, so it's one of those unfortunate things that is all too common with ageing, but it is part of the ageing process. It can also be secondary to other causes as well. This is secondary sarcopenia. So it can be related to things like type two diabetes, like I mentioned, even cancer, inactivity, which is probably one of the biggest driving forces that coupled with ageing is just a a really bad combination, and also malnutrition. And malnutrition is not just about not getting enough protein, but also not getting enough calories in, energy. I'm sorry to use the word calories when I'm talking about nutrition, but I think it's important to be verbally accurate when we're talking about this in a clinical context. Um, but a lot of people find themselves reducing, having a reduced appetite in older age. And this is a very, very common issue that we see with medicine. The older you get, the greater your muscles' anabolic resistance as well. So this is the resistance to growth, and this is where resistance training and increasing that protein consumption becomes exceptionally important because you want to introduce that stimulus to the muscle that it requires to grow in the same way as if that muscle was in a 20-year-old or 30-year-old's body. It's just a natural part of ageing, unfortunately, but it's not to say that you can't combat it, but it just requires that extra effort and the extra input of of protein as well. Interventions involving nutrition and exercise training can definitely slow down and even reverse the processes that lead to sarcopenia and eventually disability. So we want to aim for maximizing muscle mass. It doesn't necessarily mean that you need to be the biggest person in the world, but having enough muscle in youth and young adulthood is something that we want to be optimizing. It's actually one of my priorities as I turn 40 this year. You want to be able to maintain that muscle mass in middle age and minimize the loss in older age. Again, a recent chat with Professor Lee Breen on the podcast about healthy ageing, episode 291, emphasizes this need to get moving and eating protein to prevent this disease as well. And it will be the disease unfortunately of our time because we have wonderful interventions like cardiovascular interventions and drugs that can delay disease. So we get to those older years and we hit other issues like sarcopenia as well. I want to end off this section by talking about the best sources of protein. So this is a very common question we get. A lot of people are fearful of plant-based sources. They think the only sources of protein that are worth writing about are animal-based. Let's talk about protein quality. Protein quality means how well a protein source meets the body's essential amino acid needs and how efficiently it is digested and used. Typically, high quality proteins contain all the nine essential amino acids. There are non-essential and essential amino acids. The essential amino acids we cannot manufacture ourselves and we require them in adequate proportions. High quality proteins contain all these nine essential amino acids, EAAs, in adequate proportions. That's the a real important word there, adequate proportions. Complete proteins like meat, fish, eggs, dairy, soy, all have these essential amino acids in adequate proportions. Incomplete proteins, like most plant-based proteins, unfortunately, they are low in either one or more of these essential amino acids. So legumes, for example, are low in methionine, grains, I believe, are low in lysine. It doesn't necessarily mean that they don't have the nine essential amino acids, but they're just not in the right doses that are going to be meaningful for absorption and for our body to take on board. Animal proteins such as dairy, poultry, meat and fish, they're all great because according to these various measures of protein bioavailability, and some of them like protein digestibility, corrected amino acid score, PDCAAS, or there's something called the digestible indispensable amino acid score, the DIAS, they deliver, according to these scores, they deliver easily accessible amino acids that your body can readily use in high amounts for very little quantity of food. If you do a quick whistle stop tour of this protein scoring, PDCAAS is the widely used method, particularly by the FDA and the WHO, and it considers both this amino acid profile and the digestibility. And these scores range from zero to one or zero to 100%. One being the highest quality, and this is actually eggs, milk, whey and soy. So if you're looking purely at protein quality, those would be your your best bet. But most plant-based proteins score lower because of a limiting amino acid and fibre, and that affects digestibility as well. So you're always going to get a much lower score just by virtue of them not having the full collection of nine essential amino acids. And like I said, you've got this DIAS score as well. It's newer, it's more accurate than PDCAAS. It measures individual amino acid digestibility at the small intestine, called the ileum, not the total faecal digestibility. And the values can actually exceed one, giving more nuanced results as well. And it seems to be the preferred method going forward as well. You've also got some others, there's biological value, also abbreviated to BV, um, which is quite unfortunate because there's another gynaecological condition also known as BV. Um, but it measures how efficiently the body uses absorbed protein for tissue growth. Um, and eggs have a a biological value, BV, close to 100, meaning that all the absorbed protein is essentially used by the body. So you might compare eggs to um tempeh or eggs to chicken, for example. And eggs might appear to have a lower total amount of protein, but because it's just so easily absorbed by the body, you may actually end up utilising the same or more protein gram for gram. Um, that's just a, you know, a throwaway example of of how you might interpret that as well. Um, a couple of caveats, I think with all of these scoring, because it's very easy to look at this protein absorption and digestibility score, and essentially all roads lead to eggs and whey protein. If that is the one thing that you are obsessed about, eggs and protein should just be on your plate every single day. And this is why it's so popular within the bodybuilding community. It's not necessarily for health, it's more in that realm of body composition and ensuring that you're getting maximum muscle growth or strength or whatever it might be. But depending on the cut of meat that you consume, these products can contain high amounts of saturated fats. If you focus on those on your plate, they push out other ingredients that are high in fibre, nutrient dense. So we have to really think about these protein scoring systems holistically within the context of the goal that we're actually trying to achieve, which is, in my perspective and what I want everyone who's listening and watching to understand, is health, ultimate health, healthy ageing. I don't think that if we were to focus solely on protein alone, that these products should dominate our plates because we'll miss out on the complexity of other whole foods and most importantly, fibre. So this is why actually I wrote Healthy High Protein because it's about getting the balance right for protein requirements, ensuring that we've got gut healthy ingredients on our plate and reducing inflammation as well. As an example, soya, lentils, nuts and seeds, these are all fantastic because of the extra nutrients that they contain. They contain phytosterols that reduce cholesterol, fibres that support your gut health, and minerals such as zinc and magnesium. But the quantity and bioavailability of their proteins tends to be lower than in animal proteins. So if we were to, you know, using that glib example, just concentrate on protein and protein digestibility with the highest scoring, we'd potentially be missing out on all these other nutrients as well. And it limits our plate, whereas actually what we know from the research looking at the gut microbiome is that diversity is your friend, and we want to get as many different types of foods into our diet as possible. And if you use an example comparing beans and chicken, you know, the digestibility of proteins from beans and the quantity of specific amino acids they contain are lower than in chicken. So this requires you to eat far more beans coupled with other plant-based proteins like nuts and seeds to ensure that you're getting all the amino acids that you require. Chicken, on the other hand, has all the amino acids that you need packaged into an easy-to-digest format so that your body can actually utilize, and therefore less planning is actually required. However, depending on the cut and the chicken, it might contain high amounts of saturated fat. This could increase your risk of cardiovascular disease. If you only eat that, you're not getting enough fibre, you're not getting enough of those anti-inflammatory ingredients. This is why, and I know I'm harping the point here, but this is why it's very important to get that balance between protein, gut healthy ingredients and reducing inflammation as well. I think for omnivores, you're just in the best position. You know, there is this ideal solution, a whole food plant focused diet that includes small amounts of lean meat and fish coupled with a variety of plant-based proteins as well. It's kind of why I encourage a flexitarian way of eating. A Mediterranean way of eating is very flexitarian. It's got a lovely mix of these different proteins in as well. It doesn't exclude anything. Um, obviously, if you are vegan for moral reasons, there are ways around this, but it does take a little bit more work as well. It's not to say it's impossible on either a vegetarian or a vegan diet, but just a little trickier, and I think we need to be honest about that as well. There are some traditional practices that I think um people who are vegan or vegetarian could lean into, things that make the nutrients of the proteins more bioavailable um in the in these products. So soaking, also known as germinating or activating nuts and seeds, ensures that you're getting less of the uh anti-nutrients that can interfere with protein absorption, um and more bioavailability of the proteins themselves. Um there's also fermenting as well, which is why tempeh is one of my favourite ingredients because it's a fermented process, that's what tempeh actually means, of soy beans that makes the proteins in soy beans a lot more bioavailable as well. And you can also do things like sprouting. So chickpeas can be sprouted, beans can be sprouted, lentils can be sprouted, and it's just making it slightly more digestible, reducing some of those anti-nutritional factors and ensuring that your body is able to absorb as much from those as possible as well. And then there's obviously the the age-old combining as well. So combining multiple different sources of proteins from plant-based sources, beans and grains is the typical one, but you'd have to have quite a lot of beans and grains to meet most people's needs. I think nuts, seeds, um ensuring that you're getting some tofu and tempeh into your meals, particularly in Western environments where we've got access to these products, these are things that we need to be consuming as well. Protein powders often get brought up. I am a fan of protein powders as a convenient way of topping up your protein requirements if it is minimally processed, it does not have additives or sweeteners, and you're not using it as your core protein source. But I think if you can get it from whole food, please try your hardest to get it from whole food because there are just so many other benefits of getting it from whole food that you will lose if you're just relying on protein shakes alone. I hope that's cleared up a lot of the extra questions that I've had from Healthy High Protein. Uh, I'm really excited to dive even deeper into certain proteins. If you have any extra questions, let me know online. You can find us at thedoctorskitchen.com. Download the Doctor's Kitchen app if you're looking for high protein recipes or extra information about different sources of protein. There's loads of cheat sheets on the doctorskitchen.com as well. And I will speak to you next time.
