Tuesday, August 21, 2018

Response to Consumer Magazine Claims about Nuzest Clean Lean Protein

In a recent Consumer Magazine article on protein supplements, several claims were made about products I co-developed as one of the founders and formulators for Nuzest. While I think on balance Consumer do an excellent job, in this case, the claims about Clean Lean Protein and Just Fruit and Veg were spurious.

Is Clean Lean Protein high in salt?

According to consumer magazine Clean Lean Protein is high in salt.
Nuzest Clean Lean Protein Vanilla (1428mg)”

It is disingenuous to suggest that this is a ‘high’ salt load. A serve of CLP is 25 g, which would provide 357 mg of sodium. To put this in context, mortality and morbidity are increased at both high and low levels of sodium intake. (1, 2) In other words, there is a ‘U-shaped curve’ of morbidity (disease) related to extremes of intake, whether high or low. The range within which no discernible health effects are seen lies between 2,645 and 4,945 mg (1) or as high as 6000mg. (2) So, CLP provides only 6-13% of the safe daily value of sodium. As protein powders are designed to be used as major components of meals, this is a trivial amount of sodium.

Saturated Fat content of Just Fruit and Veg

“Nuzest Just Fruit and Vege Fresh Coconut topped the protein powder chart for saturated fats with 8g.”

Again, this is a trivial amount. In one serving of Just Fruit and Veg there is 3 g of fat, of which 2 g is saturated (a mere 18 calories). This amount is unlikely to cause any substantive effect in the body. Dose notwithstanding, we would question the caution against saturated fat.
Almost all systematic reviews and meta-analyses find little to no association between saturated fat intake and mortality. (3-5)  A ‘gold-standard’ Cochrane database review of randomised studies on the effect of modified or reduced fat interventions on total and cardiovascular disease (CVD) by Hooper and colleagues, there was no overall effect of reduced saturated fat diets on either total mortality (relative risk 0.98, 95% CI: 0.93 to 1.04) or for CVD mortality (relative risk: 0.94, 95% CI 0.85 to 1.04). (6) 
While substitution studies do show that replacement of some saturated fat with polyunsaturated fats improves CVD mortality outcomes, (7)  they do not find that replacing saturated fat with monounsaturated fat or carbohydrate similarly improves outcomes. So, it should be concluded that polyunsaturated fats (i.e. essential fats) are important and not that saturated fats are bad. If saturated fat independently worsened outcomes, any reduction by replacement with nutrients deemed ‘heart healthy’ (carbohydrates and monounsaturated fats) should improve outcomes, which it doesn’t. In a meta-analysis of fatty acid substitution RCTs Mozaffarian et al., stated that we “cannot distinguish between potentially distinct benefits of increasing polyunsaturated fatty acids (PUFA) versus decreasing saturated fatty acids (SFA).(8)  Therefore, based on the weight of evidence, saturated fats in the context of an otherwise healthy diet don’t increase your risk of either cardiac disease, mortality, or all-cause mortality.

Can you get all you need from diet?

 “You can get all the vitamins and minerals you need from a well-balanced diet. When you consume more than what you need in multivitamins and supplemented products, some are excreted in your urine, so it’s just a waste of money,”

While of course food comes first, and you can get all you require from diet, the reality is that most people do not.
US Department of Agriculture data shows that some fresh produce (vegetables, fruits berries) may only provide around half the amounts of some vitamins and minerals that they did in the 1950s. (9)  So, while we have been eating more (and getting bigger!) over time, and taking in more than enough calories and ‘fuel’, we aren’t necessarily getting enough of the ‘little guys’, the vitamins, minerals and secondary nutrients that act as co-factors for energy creation, hormone and neurotransmitter creation and that help to reduce the oxidative damage resulting from both environmental and lifestyle stressors, and that we create as part of our normal process of energy created within the cell.
Estimates from the New Zealand Ministry of Health ‘NZ Adult Nutrition Survey’ of 2008/2009 suggest that many New Zealanders are not getting the recommended amounts of many of the vitamins and minerals from their diets. (10)
Some of the key findings included:
·        Around 20% of people fail to get enough vitamins A (one of our major anti-oxidant vitamins, vital for gene expression, eye health and cell division), B1 and B6 (both essential for energy creation)
·        8% of people fail to get enough B12. B12 is required for proper functioning of nerve cells and without adequate B12 people can suffer from a form of anaemia and ultimately lack of B12 can permanently damage neurons.
·        Nearly 10% of women don’t get enough iron. Iron deficiency results in anaemia, lethargy and loss of muscle strength and endurance.
·        Around 25% of people don’t consume enough zinc. Zinc is extremely important for immune function and for the creation of testosterone. Interestingly nearly 40% of males may not get adequate zinc from their diet, which could increase the risk of colds, flu and reduce the ability to build muscle.
·        45% of people don’t get enough Selenium, a mineral lacking in New Zealand soils that is vital to thyroid function and metabolic rate.

Multinutrient formulas improve mortality outcomes for cancer and stroke and provide an overall protective benefit for cancer and heart disease, along with improvements in all-cause mortality. (11, 12) They can also reduce perceived stress, (13) improve sleep, (14) improve memory and cognition. (15) Overall, multis are a safe and effective way to ensure a healthy intake of essential and beneficial nutrients. (16)

Protein needs are underestimated

“While it’s true you need protein for building and repairing tissue and muscles, Ms Carey said you can get all you need from a balanced diet.
Your daily protein requirement can be calculated as roughly 0.8 to 1g per kilo of body weight. So, if you’re 70kg, you need between 56 and 70g of protein.
The latest New Zealand Adult Nutrition Survey found 98% of adults got their required daily protein intake, with some getting more than double what they needed.
Research shows that even high-performance athletes with strenuous workout regimes get no added benefit from any more than 2g of protein per kg of body weight.”

Many people, in contrast to the statements above, do not get enough protein to thrive.
In both NZ and the US, the average intake of protein is around 100 g and 70 g for males and females respectively. (10, 17) While this is higher than the recommended daily intake of 0.8 g/kg/day it is below the recommended levels for both performance, and for offsetting age-related muscle loss. Analysis of US eating patterns has suggested that people should actually be aware of eating enough protein, not reducing their protein intake, especially as protein intakes decline as we age. (18)
Protein is important for everyone and especially important as we age. Age-related muscle loss is common and is a contributing factor to falls and bone and joint injury. This muscle loss also increases our risk of metabolic disorders like diabetes. In older adults, high-protein nutritional supplements are associated with lower hospital admissions and fewer health complications. (19) Increased protein also allows us to retain more lean mass and lose more fat. (20)(21) Higher protein diets are also good for ‘cardiometabolic’ health. Increased dietary protein has a beneficial effect on blood pressure, triglycerides (one of the most important markers of poor cardiovascular and metabolic health), and reduces body fat. (22, 23) For those dieting, or even those who are just habitual under-eaters, an increased protein intake of up to 2.5g per kilogram of body weight is likely to help offset muscle loss, and thus improve body composition (muscle to fat ratio). (24) This level of protein is around 3 x higher than the recommended daily allowance of 0.8g per kg body weight. Not only that but for ‘weekend warriors’ training for sports, or at the gym, protein taken after training might reduce soreness. (25) And in healthy adults, over the long term, protein is likely to increase lean muscle and help to improve strength and power. (26)

Are animal-derived proteins superior?

"Choosing whey-, egg- or soy-based protein powders is also better because they have good amino acid profiles and are quickly digested.
Protein found in meat, fish, poultry and dairy products has all 20 of the amino acids our bodies need. Two plant foods, soy and quinoa, are also complete proteins. Other foods, such as peas, tofu and oats, also have protein, but not all of the amino acids. So, while you’ll still get protein from a pea-based powder, it’s not a complete option."

Pea protein isolate, like that in Clean Lean Protein has an amino acid profile that compares favourably with the recommended amino acid pattern proposed by the Institute of Medicine of the United States National Institutes of Health. (27) It contains all 9 essential amino acids and in an evaluation of pea protein isolate vs. whey protein both protein-types elicited nearly identical increases in muscle thickness when compared with placebo. (28)
Also worth considering, while dairy is fine for most people, it is also a common allergen, and there appears to be a rising incidence of milk protein intolerance and allergy. (29) Egg too can be a common allergen, and soy is high in phytic acid and other ‘anti-nutrients’ making it less favourable than pea protein isolate.

1.            Graudal N, Jürgens G, Baslund B, Alderman MH. Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality: A Meta-Analysis. American Journal of Hypertension. 2014.
2.            Alderman MH, Cohen HW. Dietary Sodium Intake and Cardiovascular Mortality: Controversy Resolved? American Journal of Hypertension. 2012;25(7):727-34.
3.            Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab. 2009;55(1-3):173-201.
4.            Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. The American journal of clinical nutrition. 2010;91(3):535-46.
5.            Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;169(7):659-69.
6.            Hooper L, Summerbell CD, Thompson R, Sills D, Roberts FG, Moore H, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev. 2011(7):CD002137.
7.            Jakobsen MU, O'Reilly EJ, Heitmann BL, Pereira MA, Balter K, Fraser GE, et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr. 2009;89(5):1425-32.
8.            Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010;7(3):e1000252.
9.            Davis DR, Epp MD, Riordan HD. Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999. Journal of the American College of Nutrition. 2004;23(6):669-82.
10.         University of Otago and Ministry of Health. A Focus on Nutrition: Key findings of the 2008/09 New Zealand Adult Nutrition Survey. Wellington; 2011.
11.         Huang H-Y, Caballero B, Chang S, Alberg AJ, Semba RD, Schneyer CR, et al. The Efficacy and Safety of Multivitamin and Mineral Supplement Use To Prevent Cancer and Chronic Disease in Adults: A Systematic Review for a National Institutes of Health State-of-the-Science Conference. Annals of Internal Medicine. 2006;145(5):372-85.
12.         Alexander DD, Weed DL, Chang ET, Miller PE, Mohamed MA, Elkayam L. A Systematic Review of Multivitamin–Multimineral Use and Cardiovascular Disease and Cancer Incidence and Total Mortality. Journal of the American College of Nutrition. 2013;32(5):339-54.
13.         Macpherson H, Rowsell R, Cox KHM, Scholey A, Pipingas A. Acute mood but not cognitive improvements following administration of a single multivitamin and mineral supplement in healthy women aged 50 and above: a randomised controlled trial. AGE. 2015;37(3):1-10.
14.         Sarris J, Cox KHM, Camfield DA, Scholey A, Stough C, Fogg E, et al. Participant experiences from chronic administration of a multivitamin versus placebo on subjective health and wellbeing: a double-blind qualitative analysis of a randomised controlled trial. Nutrition Journal. 2012;11(1):1-10.
15.         Harris E, Macpherson H, Vitetta L, Kirk J, Sali A, Pipingas A. Effects of a multivitamin, mineral and herbal supplement on cognition and blood biomarkers in older men: a randomised, placebo-controlled trial. Human Psychopharmacology: Clinical and Experimental. 2012;27(4):370-7.
16.         Biesalski HK, Tinz J. Multivitamin/mineral supplements: rationale and safety – A systematic review. Nutrition.
17.         Moshfegh A, Goldman J, Cleveland L. What we eat in America, NHANES 2001-2002: usual nutrient intakes from food compared to dietary reference intakes. US Department of Agriculture, Agricultural Research Service. 2005;9.
18.         Fulgoni VL. Current protein intake in America: analysis of the National Health and Nutrition Examination Survey, 2003–2004. The American Journal of Clinical Nutrition. 2008;87(5):1554S-7S.
19.         Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Research Reviews. 2012;11(2):278-96.
20.         Kim JE, O’Connor LE, Sands LP, Slebodnik MB, Campbell WW. Effects of dietary protein intake on body composition changes after weight loss in older adults: a systematic review and meta-analysis. Nutrition reviews. 2016;74(3):210-24.
21.         Kim JE, Sands L, Slebodnik M, O’Connor L, Campbell W. Effects of high-protein weight loss diets on fat-free mass changes in older adults: a systematic review (371.5). The FASEB Journal. 2014;28(1 Supplement).
22.         Altorf – van der Kuil W, Engberink MF, Brink EJ, van Baak MA, Bakker SJL, Navis G, et al. Dietary Protein and Blood Pressure: A Systematic Review. PloS one. 2010;5(8):e12102.
23.         Santesso N, Akl EA, Bianchi M, Mente A, Mustafa R, Heels-Ansdell D, et al. Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis. Eur J Clin Nutr. 2012;66(7):780-8.
24.         Helms ER, Zinn C, Rowlands DS, Brown SR. A Systematic Review of Dietary Protein during Caloric Restriction in Resistance Trained Lean Athletes: A Case for Higher Intakes. International Journal of Sport Nutrition and Exercise Metabolism. 2014;24(2):127-38.
25.         Pasiakos SM, Lieberman HR, McLellan TM. Effects of Protein Supplements on Muscle Damage, Soreness and Recovery of Muscle Function and Physical Performance: A Systematic Review. Sports Medicine. 2014;44(5):655-70.
26.         Pasiakos SM, McLellan TM, Lieberman HR. The Effects of Protein Supplements on Muscle Mass, Strength, and Aerobic and Anaerobic Power in Healthy Adults: A Systematic Review. Sports Medicine. 2015;45(1):111-31.
27.         Hansen K, Shriver T, Schoeller D. The effects of exercise on the storage and oxidation of dietary fat. Sports Med. 2005;35.
28.         Babault N, Païzis C, Deley G, Guérin-Deremaux L, Saniez M-H, Lefranc-Millot C, et al. Pea proteins oral supplementation promotes muscle thickness gains during resistance training: a double-blind, randomized, Placebo-controlled clinical trial vs. Whey protein. Journal of the International Society of Sports Nutrition. 2015;12(1):3.

29.         Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: A meta-analysis. Journal of Allergy and Clinical Immunology. 2007;120(3):638-46.

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