8 signs you need more protein - Dr. Westman Interviews



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Dr. Westman interviews Dr. Mike and Dr. Mary Dan Eades: 8 signs you need more protein

Dr. Eric Westman: We’re joined with Amy Berger and physicians and New York Times best-selling authors of the book Protein Power, Doctors Michael and Mary Dan Eades. They’re here to talk to you about the eight telltale signs you need more protein in your diet. I will now hand over to Amy Berger to introduce you to Dr. Michael and Dr. Mary Dan Eades. Take it away, Amy.

Amy Berger: Welcome to our Protein Workshop with Doctors Michael and Mary Dan Eades. This is a workshop all about protein and the signs that you need more protein. It’s coming to you from Adapt Your Life Academy. I am Amy Berger, a low-carb and keto nutritionist. I am the head nutritionist and lead writer at Adapt Your Life Academy, and I’m just the MC here. The real stars of the show are Doctors Mary Dan and Mike Eades. If you’re relatively new to keto and low-carb diets, you might not know who these two people are because there’s a lot of new influence from YouTube and social media. I would like to give you a quick introduction to the Eades.

As far as I’m concerned, you will be in the presence of low-carb royalty this evening. They’ve written several books, but one of their most popular and famous books is Protein Power, which came out in the mid-1990s. I reread it again recently. It is every bit as relevant, helpful, and important today as it was then.

The Eades have been in the low-carb space longer than just about anybody. There is probably no one better to learn about protein from than these two people. They are both physicians, and they had a practice for many years where they were some of the earliest people doing low-carb diets to help people lose weight, reverse diabetes, and all that good stuff that we know this way of eating does. Those of you who happen to be fans of Dr. Westman, Dr. Westman was not born knowing about low-carb and keto diets. He didn’t learn about them in medical school, so the Eades were some of his teachers when he was brand new to this. All of that to say that you may not have heard of them if you’re new to this way of eating, but these are real, true experts, and you are in for a real treat. We’re so lucky to have them.

Hello, Drs. Michael and Mary Dan.

Dr. Mary Dan Eades: Hey, Amy, how are you?

Amy Berger: I’m well. I’m well. You guys take it away.


Dr. Michael Eades: As Amy said, we’ve been practicing for a long time. We have been treating patients with low-carb ketogenic diets since the early 1980s, so I guess that makes it about 40 years now. We’ve had thousands and thousands of patients, lots of experience; we’ve seen it all in terms of low-carb. We’ve written 14 books together on medical and health conditions. The Protein Power book they mentioned back in the 1990s sold a whole lot of copies and was named Protein Power because that’s what the publisher wanted to call it. We didn’t really like that title, but now it’s become a great title. So, they were a lot smarter than we were.

The basics of protein

Dr. Michael Eades: When you talk about protein, there are three macronutrients, the things that give you calories: protein, carbohydrates, and fat. Of those, protein is really the most critical because it’s the only one that is truly a macronutrient. The others are basically fuel sources. You get fuel from fat, and you get some essential fatty acids. Mainly, fat is a fuel, and carbohydrates are a fuel. There is no essential carbohydrate. It is strictly used as fuel. The body can shift from one to the other. The body can also use protein as fuel, but it doesn’t really like to because it would rather preserve that and use it to build muscle, enzymes, and all your protein structures. That’s the difference between a nutrient and a fuel.

Dr. Mary Dan Eades: Protein, when you talk about building things with it, itself is made of building blocks. Many of you will know this. There are 20 amino acids that make up every protein in the body. There are about 10,000 proteins or more in the human body that we have to make all the time. Our need for protein is never-ending. It’s the one thing we absolutely must have. It’s the cornerstone of human nutrition because it does so many things in the body – it supports hair, skin, nails, bones, organs, your heart, lungs, liver, pancreas. Everything about you, including hormones, neurotransmitters, enzymes – everything that makes the body work is basically a protein structure. We use it up, wear it out, and we have to replace it. There’s really no reservoir of protein in the body other than your lean body mass, which you don’t want to consume. You want to build and strengthen it. Therefore, dietary protein coming in regularly with all of the essential 20 amino acids is important.

Of those 20, there are eight essentials, and the rest of them can be made out of those eight if you give your diet enough protein to do that. Of the essentials, there are a couple of them that are very important if you’re trying to build muscle and build your lean body mass back up.

Second only to water, protein is the most critical nutrient for human health. As Mike said, there are no carbohydrate deficiencies known, not a single one. But there are two important protein deficiencies known. You may have heard of those. One is called kwashiorkor, and one is called marasmus. These are extremes – children in Africa with bloated bellies, distended bellies, swollen hands and feet, or tiny babies whose little arms you could put your fingers around. Those are extremes of protein malnutrition. But you don’t have to go to that extreme to find consequences of a lack of protein in your diet.

Dr. Michael Eades: In young people, protein is absolutely critical for growth and brain development. A lack of it stunts growth, impairs cognitive function, and can lead to more infections. That’s why a lot of these countries with malnutrition have a lot of cognitive impairment. They really need the protein, and they need iron, too. There are a few times in your life when your protein needs really increase. One of them is when you’re young and growing, because you’ve got to build body structure – bones, muscles, everything is made of protein. Even your bones, you think of bones being calcium. Well, it’s calcium on a protein kind of a template or matrix. When you’re young, you really need protein; you really need plenty of it.

When you’re old, you need protein because once you reach about age 30, we’ll talk about a little bit later, you start to lose protein. So, you constantly have to eat more, and you have to work out to keep from losing your muscle mass. About half of the elderly don’t get enough protein, and about 7% of children worldwide are thought to be deficient in protein, which is incredible.

Signs of protein deficiency

Dr. Mary Dan Eades: The signs of protein deficiency are what we’re going to talk about today because everybody probably thinks they get enough protein. “I eat plenty of protein.” But you might not, especially if you’re over 30. The young and the growing have to build a complete body from the ground up and grow it quickly, under the influence of hormones driving their growth. If you give them enough protein of almost any kind, they’re going to gobble that up and turn it into a lean body. But once you pass about 25 to 30, that hormone will drive those away, and what’s driving muscle building at that point is dietary protein. You’ve got to have enough to trigger dietary protein to build new muscle, new lean body, which you need. But we’re going to talk about the signs of lack, and among them, the first thing that anybody would think of, of course, is muscle loss or muscle weakness. If you don’t get enough protein in the diet, your muscles can’t repair the wear and tear of living, even if you’re not working them very hard.

If you’ve ever been in the hospital, maybe – and I’ve certainly seen this – I even had that happen to me, you get into the hospital, you’re sedentary and bed for a few days, and you become so weak when you get out. You almost can’t walk. I had a bad car wreck when I was young and ended up in the hospital for a week because of that. In bed, when I got out, I was 19 years old, I could barely walk to the car because of how quickly you lose the strength and the stamina in your muscles when that happens. It’s worse when you’re older, and you have a relative who gets a hip fracture and stays in bed for a long period of time. They really do try to mobilize them because it’s so important not to let your muscles sit. You probably know firsthand how quickly it can happen to you – how quickly you can lose muscle mass and muscle strength. A sign of relative protein malnourishment is if your muscles begin to dwindle or if you are weaker than you used to be. You can’t open jar lids, you can’t get heavy things down from above your head, you can’t get your carry-on in the overhead bin. There’s a million things, just day-to-day living, that depend on good quality protein coming in the diet to keep your muscles strong.

Dr. Michael Eades: Increased risk of fractures, more infections, low healing of fractures, and even wound healing – just thinning and dryness of hair, skin, nails, organs, swelling of your feet and ankles, because a lot of people don’t realize protein is what basically holds the blood inside the blood vessels. If you don’t have enough protein, it can seep out. That’s why these kids can get big bellies, and that’s why people can get edema. They don’t have enough protein. Brain fog, fatigue, memory disturbance, agitation, even cognitive impairment in later years – it just goes on and on. Protein impacts all of these conditions.

Dr. Mary Dan Eades: Absolutely does. We’ve talked a little bit about muscle loss – your muscle mass is basically like a savings account for good health. In age, you depend on it more than anything else. In fact, that’s one marker for longevity – what your muscle mass is for your relative size. Muscle mass equals protein. It couldn’t be more important than that. But bones too, because the muscles are on a framework that’s a bony skeletal framework. As we age, bones thin and they get weaker. The risk of fractures, simple fractures from a fall or major fractures like a hip fracture, goes up. That’s a real thing that happens to an older person that’s hard to come back from for a lot of folks.

As Mike said earlier, the whole matrix that bones exist upon, we think of calcium and all the minerals – manganese, phosphorus, and boron and all the things that go into bone. But those things are just hung on that protein framework. It’s a collagen protein framework, and so you’ve got to keep it repaired and replaced in order to have something for the vitamin D and the estrogen or the testosterone or whatever to hang those minerals on to make your bones strong. You know, the early man had very strong bones; he was a meat-eater, and she was, too. They were both meat-eaters, and they had cortical thickness in their bones much better than we have in our bones today. So, it’s important that you do that.

We can all benefit from more protein

Dr. Michael Eades: The thing that plagues people as they get into later years, probably more than anything else, is a condition called sarcopenia. And sarcopenia means muscle wasting. We’ve all seen it in elderly people – their limbs just shrivel away because that’s where a lot of the muscle mass is. In order to maintain that, they’ve got to keep protein intake up, and it’s really difficult to keep protein intake up unless you eat foods of animal origin. It’s just tough to do because of some of the particular amino acids in those foods that drive the whole system that builds and maintains protein. Not only do you have to eat a lot of protein to keep it going, it’s really a struggle, it really is, you’ve got to work out, too. You’ve got to do some resistance training. It’s just a constant battle when you reach later in life to maintain your lean body mass that, as Mary says, is so important. It’s like money in the bank for you, metabolically, because it’s in the blood, it helps regulate blood sugar, and it’s a reservoir for all your amino acids to make all your enzymes and everything that requires protein. It’s just a constant battle against nature because nature wants you to give it up, and you want to keep it.

The longer you can keep it, the longevity is associated with the greater muscle mass. You’ve got to work. When you’re a kid, when you’re growing, up to age 30, you can grab protein from just about everything you eat. Even if it’s just got a minuscule amount of protein in it. But when you get over the age of 30, the battle starts. When you’re 60, it’s a lot harder than it is at 30. The older you get, the more difficult it becomes and the harder you have to work to maintain it. But, believe me, it pays huge, huge, huge dividends.

Dr. Mary Dan Eades: Absolutely. People think, “I probably get enough during the day,” but there’s a protein threshold that you’ve got to hit in a single dose, as an adult, to give the signal, “It’s okay for me to synthesize some muscle, to build some muscle.” That comes from the branched chain amino acid leucine, primarily. You want to have all 20 amino acids in your amino acid pool, richly, of course, if you’re going to build muscle or bone or whatever. Leucine, especially, is a trigger for building muscle, and you need about two and a half to three grams of leucine in a single dose – in a single meal – in order to give the signal to build. That’s usually 25 or 30 grams of protein total in, say, a chicken breast or a chicken thigh or a bunch of eggs. But you need that good signal or you’re not going to build. And then you want to work. You’ve got to work the muscle against a load to build muscle and bone.

Dr. Michael Eades: As Mary says, working the muscle against the load not only builds muscle but builds bone as well. You’ve got to have the bone structure to hang your muscles on. It’s really important in both cases. It’s really important for bone healing. If you’re elderly and you break your hip, if you have plenty of protein, it will heal a lot faster than if you’re limited on protein. If you break your hip a lot of times, you go to the hospital and you get a wretched diet. It’s not going to have enough protein. It’s going to have plenty of carbs, but carbs don’t do anything to build muscle. You want to make sure that you’ve got plenty of protein coming in so that you don’t break your hip, and if you do, that you’ll survive it and rebuild it quickly.

Dr. Mary Dan Eades: You know, to a degree, the same thing’s true for any injury or for surgery of any kind. It doesn’t have to be a hip fracture. If you’re an active person, and end up straining an ankle or a knee or shoulder or whatever, it’s the same thing. If you’re going to heal that as an adult, you’ve got to drive the protein, particularly the branched chains – things like meat, eggs, and milk – in order to have the raw materials there to be able to repair, replace and rebuild, when something like that happens.

Dr. Michael Eades: Even if you’re a kid. We make it sound like you don’t need protein, but you really do. You need a lot because you’re growing. If you want to grow as a kid or maintain the growth of your kids or your grandchildren, make sure they get plenty of good quality protein. There are all kinds of other places that you lose protein and need protein from. You shed the lining of your gut regularly. Every time the cell replaces itself, you need protein for that.

Dr. Mary Dan Eades: You replace the entire lining of your gut about every few days or weeks. It’s often the entire lining of your gut, which is where the rubber meets the road for digestion. If you want your digestion to be good, you’ve got to focus on having a good gut lining. And to have that, you’ve got to have enough protein coming in to build, rebuild, and replace all that loss.

Dr. Michael Eades: Your entire immune system is made of protein. Protein prevents you from getting sick more often. It’s just an absolute requirement for a robust immune response and to make immunoglobulins, antibodies, and all the different white cells to fight infection. Those are all protein-based.

Dr. Mary Dan Eades: We’ve talked about how important it is for wound healing, to have plenty of protein. Think of that in terms of a cut injury. “I’ve got to heal, I’ve got to heal a fracture.” But another place where it’s very important, and I think people don’t probably get it when they need it, is if you hurt the heart muscle in some way, have a heart attack. You’ve got to heal it with the tissues that build new heart muscle. And so you’ve got to have plenty of protein any time you get an injury, an illness, take a fall, bang yourself up. You’ve got to have it.

Dr. Michael Eades: Use it for even things you might not think are that important. Your hair, for example, it’s protein. If you’ve got dry, brittle hair, more protein generally helps that. Same thing with brittle nails and ridges in your nails.

Dr. Mary Dan Eades: How many hairs do you think we have on a human head? About a hundred thousand. When they shed, you’ve got to replace them from the follicle all the way out. That’s a constant turnover of protein. If you don’t have enough protein, the hair that’s there hangs around and doesn’t get forced out by new growth. Then you have dry, lifeless, brittle hair.

Dr. Michael Eades: You can have crummy skin. It’s dry, it gets thin, it has a low moisture content of the skin – wrinkly and crepey. As I mentioned before, even the fluid part of the blood has to have protein to maintain the fluid in the blood vessels. People don’t realize this, but blood vessels are porous. If you don’t have protein to keep the fluid in, it just oozes out. You’ve got to have protein for that.

Dr. Mary Dan Eades: Not only that, but the blood cells, themselves, not just the white blood cells but the red blood cells as well, are made of protein. Hemoglobin is a protein – that’s the oxygen-carrying pigment in every red blood cell. The life of a red blood cell is about 120 days. Every 120 days, you’ve got to have a new one to take its place. In a human body, there are between 20 and 30 trillion red blood cells. Of the number of cells in your whole body, 70% of them by cell number are red blood cells. They get turned over, and you’ve got to replace them every 120 days. You’ve got to have protein to do it, and iron.

Dr. Michael Eades: As I mentioned before, you need a lot of protein. Protein to build white blood cells, your immune cells. You have too few if you have a protein deficiency, like we talked about before. Swelling in the feet, swelling in the ankles, and by the poor kids Mary was talking about, who get these big bellies, that’s because they don’t have enough protein to hold the blood in, and it seeps out into their abdominal cavity. That’s why they have these big bellies even though they’re starving. They’ve got little bitty limbs, but big bellies because they can’t hold the fluid in the blood, and it seeps out into their abdominal area.

Dr. Mary Dan Eades: There’s a quick cure for that: good quality protein. Even if they have enough calories to support themselves, if they don’t have enough protein, they’re going to suffer from this kwashiorkor. They can’t keep the fluid part of the blood where it belongs. They’ll have all these other hair, skin, nail, and cognitive problems. But they can all be fixed by giving them complete protein, like milk. It’s perfect, milk or meat or eggs.

Dr. Michael Eades: Unfortunately, most of them get way too little, and mainly plant protein, which is generally insufficient in certain amino acids to make the proteins that they need to hold the fluid in the blood vessels. A tragic situation.

Dr. Mary Dan Eades: Kwashiorkor means “sickness that occurs when the next child comes.” When a toddler gets weaned from human breast milk onto something like cream of wheat, boiled rice, they get sick because they’re not getting complete protein. And the new baby will also suffer kwashiorkor when her next baby comes. It can all be fixed just with protein.

There’s another major organ that can be protein-dependent, and that’s your brain. We’ve said that people who eat on the higher end of the protein scale as they age have less likelihood of having senile cognitive decline, and that’s true. But all kinds of things that make our brains work and make us work also are protein-based: neurotransmitters, and many of them are serotonin, tryptophan, the one you get when you eat turkey at Thanksgiving. It makes you go to sleep. GABA, glutamate, I mean, all of these, dopamine, all of these neurotransmitters are protein-based too. When you don’t get enough protein, you can start having issues related to all of these. It’s a very tight, orchestrated interplay between all these things, and when they get out of sync, things happen. You have brain fog, you can’t recall words, you can’t think clearly. You have that mid-afternoon slump where you can’t wake up, and you can have difficulty learning new things. Or kids, if they’re just learning things, can have difficulty if you don’t have all the required numbers and amounts of neurotransmitters, all of which are protein-based. Every single one of them.

You can make a huge difference in cognitive ability in kids by giving them plenty of protein. I think over the years, I’ve told parents a million times that I don’t care what else your kid eats as long as he or she eats the protein, because that’s the single most important, the most critical nutrient for building a strong and healthy child and maintaining a healthy adult.

Dr. Michael Eades: It’s protective in the elderly, too. It’s not just kids.

Dr. Mary Dan Eades: People could do a worldly good in nursing homes, feeding them some protein.

Dr. Michael Eades: Unfortunately, they feed them just the opposite, usually.

Protein also helps with weight loss, and it helps with weight gain for people who want to gain weight, want to build muscle. Protein is not just burned up like carbs and fat, which are either burned up or stored. It’s used. In the process of breaking it down and converting it into what it needs to be converted to, it chews up some calories, and so it ends up having what’s called the thermic effect of food (TEF). It makes you burn more calories than you would otherwise burn if you didn’t have the protein because it’s “metabolically expensive.” Your body has to spend a lot of energy to move it around and do what you need to do with it.

Dr. Mary Dan Eades: There’s a theory – it has not been proven in humans, but it has been shown in animal studies – that creatures will eat until they meet their protein requirements. If you feed them a very low protein diet, then they end up eating a lot more of that low protein diet, seeking to get the requisite amount of protein that their little furry bodies know they need. The same thing is true to a degree in humans, although the research is not nearly as strong, I don’t think, as it is in animals. If you try to subsist on a low protein diet or a diet of not good quality protein, then you end up eating a lot more. That can lead to weight gain of the type you don’t want, or a stall in weight loss, which can be disconcerting and unwelcome when you’re trying to lose weight. Many times throughout the years with patients, I’ve had to tell them, “If you want to lose weight, I need you to eat more. I specifically need you to eat more protein.” It needs to be the first thing you think about when you’re building a meal: get your protein in and then surround it with some other things that are within your carb limit or with what fits your taste palate or makes your life better in some way as long as they don’t make your metabolism worse in some way.

Protein is the cornerstone. When they eat more protein, what they find out when they’ve been in a slump with weight loss, is that the weight loss picks up, and it picks up for a couple of reasons. Protein is satiating to the appetite, and when you eat it, just like in those animal studies, it’s like your body knows, “Oh, I’ve actually been fed,” and that’s really true when it comes to muscle synthesis. When you get over that threshold, your body knows. It triggers, “Oh, I can build muscle. I’ve got enough incoming nutrients that I can actually do something with.” That’s a strong signal. When my patients do this and they start eating more protein, they end up losing weight better. They get back on their weight loss. They actually probably eat fewer calories because protein is so satiating that you’re happy, you’re content, your appetite is satisfied with fewer calories. What you want to do is make the calories you eat count. Make them count for something. It needs to be nutrient-dense – animal sources of protein certainly are nutrient-dense – and give you everything that you need to build and maintain a lean body that’s strong and healthy and metabolically fit and that will take you into your older age and you’re happy to be there, not wishing you weren’t. Being able to do the things that you want to do as you get older, even if getting older means over 30, which it does, it just all comes down to the protein.

Dr. Michael Eades: Everybody’s talking about these weight loss medications. They cost you about $1000 a month and people are having pretty significant weight loss on them, but I did an analysis and when you get into the down into the weeds, out into the supplementary materials that don’t even show up in the main paper, that’s even hard to find there and I had to do a lot of calculations to come up with this – out of the weight people lose, it’s almost all muscle mass, because these shots just make them not particularly hungry. When they’re not hungry, they don’t eat. When they are hungry, they probably eat foods that they shouldn’t eat. There are a lot of articles about this in the press right now that a lot of food companies and even a national donut chain are getting concerned because they think their revenue is falling because people are getting these shots and they’re not going out eating all this junk food and fast food, which was why they got overweight in the first place. They now just quit eating. What happens to these people is they lose their lean muscle mass, and they think that they’re doing great because they’re losing weight. But ultimately – and studies have also shown this – when people stop taking the shot, they regain the weight. The problem is, when they regain this weight, they’re not going to regain the muscle mass along with it. They’re going to regain mainly fat. When they regain the fat, they’re going to be in a situation where they’re getting less lean body mass than they did before they started on the shots. Whatever they do after that is going to make it that much more difficult because they’re not going to have the underlying muscle mass, the metabolic engine, so, it’s going to be a real struggle. A million people ask me about these shots and if they should do it. Absolutely not. It’s so easy to be on a diet and a whole lot less expensive.

I’m really concerned about that society because I think a lot of people are in for some big-time disappointment when all this unravels. That’s just my caveat about those things and also my caveat about just going on a really low-calorie diet, because when you go on a low-calorie diet, you generally go on a low-protein diet. You can lose weight by replacing carbs or fat with protein. I can’t tell you how many papers there are out there that looked at that. It’s well established that if you’re replacing carbs or fat with protein, you’re going to lose weight. But if you really want to do it, you replace carbs with protein and you lose a lot more because fat doesn’t have the metabolic consequences that carbs do. You will end up eating less overall over the long run.

Your optimal diet is a combination of fat and good quality protein, which comes nicely packaged in foods of animal origin.

Dr. Mary Dan Eades: In nature. Nature knows, once again.

Dr. Michael Eades: Have you ever seen fat and carbs together in nature in concentrated large amounts? Fat and carbs generally don’t come together in nature.

Dr. Mary Dan Eades: We’ve been at this protein thing, as Mike said at the outset, for a long time, for 40 years. We’ve seen the travails and the successes of a lot of people who were struggling with their weight and struggling to help corral a metabolism that was out of sync. What we’ve learned through all those years is that the most important thing you can do is feed yourself properly, just figure out what it is that your body needs and give it to it.

I think of one patient I remember who had a great journey. He had a journey that began as a runner. He was a guy who would commit 100% to anything he did. So, he committed 100% to running, and he was running like a hundred miles or more a week. He beat himself up running and had a typical runner’s physique, very lean, skinny – legs, pretty muscled, but the rest of him, not so. He made himself sick running too much. He decided to commit himself fully to eating, and he ate himself up to a really tremendously large weight. The picture we saw of him on the cruise ship, he almost couldn’t get his arms to the table because his stomach was so big. He was an all-or-none kind of guy. He ended up coming to us, and he was 57 years old. That’s not a time that generally people think, “Oh, I can remake myself into this great physique.” But you just want to get healthier. Well, not Stan. Stan made himself into a great physique. He lost a lot and then started working out. If you think at 57 that you can’t re-tighten yourself and look lean and virile, he did. He ended up becoming a competitive bodybuilding-type weightlifter. He just went to the nth degree. The story of Stan is there to remind us that it’s absolutely never too late to change the way you eat and change your life, and it’s all in your hands. That’s the beauty of it. Once you know how your metabolism works and you know all about protein, you get to decide. You get to pick the outcome. It’s all in your hands.

Dr. Michael Eades: Absolutely. As I always tell every patient, you have absolutely 100% control over everything. You just have to choose to make the right choices, and the right choice really always needs to include a fair amount of good quality protein. Not necessarily plant protein, which is not the best for a whole host of reasons, but that about wraps up what we wanted to say about protein.

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