Protein First: How the New Dietary Guidelines Shift Nutrition

0:00The new guidelines recognize that whole nutrient dense food is the most effective path to better health How would you describe why we would have guidelines just in general? I think the origins of it came out of the end of World War II and people started getting more oriented to public health and the well-being of everyone. And people realized that heart disease was a real cause of mortality. And so they started to look for reasons why. Also during World War II, they were interested in the fact that there are a million people, men overseas, fighting a war. And they had to have some idea of how much food to send.

0:35So I think those were the two things that really brought nutrition to the forefront. How do we define what people need? Protein and healthy fats are essential and we're wrongly discouraged in prior dietary guidelines. What Kennedy is saying is what we need to base our science on is well-controlled studies and if we don't have well-controlled studies, we shouldn't make conclusive answers. This is a monumental moment for Americans. The dietary guidelines...

1:11Dr. Donald Lehman, welcome to the show. You are no stranger to this. You're probably the most frequently returning guest. Welcome. It's good to be back, even on the roadshow. You know what? I think we should probably create a Dr. Don Lehman and co-roadshow on nutrition. We're actually in D.C. This is a monumental moment for Americans. the dietary guidelines i just have chills thinking about have changed and the listener or viewers thinking two things right now wow these guys are total nerds like who cares about it or number two maybe there is something more to nutrition for optimal health and that the problems that we're chasing begin on our plate as opposed to looking for more medication to change obesity and heart disease and all the other chronic diseases.

2:05With these changes, potentially with prioritizing protein, which is unbelievable, hasn't changed the original guidelines at 0.8 grams per kg. They haven't changed in over since, I mean, since ever, have they? No, that's been the RDA forever. And that RDA hasn't changed, but we've highlighted the fact that an optimal range is probably about twice that, 50%, you know, 1.2 to 1.6, so 50 to 100 % above the minimum. And we should touch on what the old guidelines were for the people listening or watching the show that have never really spent time thinking about the dietary guidelines before we move to the new and improved incredible upside-down pyramid.

2:52What were the old guidelines, roughly speaking. Yeah, the old guidelines in my mind were more about what you shouldn't eat than what you should eat. It was using the minimum protein intake of 0.8 grams per kg, which is just a minimum to prevent deficiencies. But it was about not eating cholesterol, not eating saturated fat, not eating sugar, not eating any salt containing products. So it was all about what you shouldn't eat. They did have some guidelines about eating a variety of foods and things like that and maintaining normal weight. But really, when they started structuring what people should do, it was really about avoiding anything that had fat in it and eating things that had a lot of carbohydrates.

3:37Seems really counterintuitive that the guidelines, if we were to think about what the guidelines, what their use is, how would you describe why we would have guidelines just in general? I think the origins of it came out of the end of World War II, and people started getting more oriented to public health and the well-being of everyone. And people realized that heart disease was a real cause of mortality. And so they started to look for reasons why. Also, during World War II, they were interested in the fact that there are a million people, men overseas, fighting a war, and they had to have some idea of how much food to send.

4:13So I think those were the two things that really brought nutrition to the forefront. How do we define what people need? Would you say, and I don't actually know this number, would you say that the majority of people follow the current dietary guidelines? I mean, I know that answer, but I don't know the percentage. Yeah. People often ask me, you know, what difference does the dietary guidelines make? And for the average person, none at all. They totally ignore it. Most people don't even know it exists. But the reality is they have a big impact on any group that gets any government support. So school lunch, daycares, nursing homes, even prisons or hospitals or the U.S.

4:55military, they all have to follow these guidelines. So there's a huge impact across the nation in terms of, do these guidelines really represent a healthy way to go? They really haven't changed. They reevaluate them every five years. Is that true? Right. But to your point about they don't change, one of the guidelines, one of the rules that have governed the process is you can never go back and look at the prior information. You can only change based on what has happened. So if you started in 1980 with a false idea about saturated fat, 45 years later, you still have that same false idea. And I think that's one of the big changes is that when Secretary Kennedy and Secretary Rawlins came in, now they said, no, we don't care what has happened.

5:45We only care about what's real. So let's reevaluate all the science. The new guidelines, the high level. Can you share some of those recommendations now? So the recommendations, I think, are very logical. They're very flexible. They start out with everybody needs to target their calorie intake. We have a huge obesity problem. So that's simple. So we need to get that under control. And that's partially food you choose, but partially portion control. The second thing, which is really a big priority, is prioritizing protein foods. Protein foods are the primary source of nutrients in our diet, whether it's amino acids or whether it's vitamins and minerals.

6:27Protein foods are where we get our 65, 70 % of our nutrients. So you have to make a priority to that. From there, they went in and say typical things like fruits and vegetables, which is what you'd expect. Healthy fats, which is a big change, prioritizing natural fats, things that you would get from foods from animal sources, milk, eggs, meats, things of that nature, along with olive oil and other natural and less use of highly processed seed oils. And then into carbohydrates, people need to restrict that really in line with their energy needs, and particularly favoring more whole grains. So that's kind of an overview of the layout, and it's really presented as bullet points, which are very easy to understand.

7:18Why do you think, from your perspective, has protein not been addressed previously? I think that the main reason is that most animal proteins, which are probably the most nutrient-dense proteins in the food supply, are also source of cholesterol and saturated fat. So I think they were trying to avoid it. There's been a longtime push that we needed a more plant-based diet. So that's sort of been an underlying. So I think that's really been the main issue. It's sort of been behind the cloak of that saturated fat issue. They increased the protein by 50 to 100%, which is extraordinary. And to highlight, the 0.8 grams per kg was based on the RDA.

8:05Well, it's based on nitrogen balance to inform the RDA. Can you just speak to that really quickly? So the RDA created back in the 70s, really, was trying to get a minimum number of protein that individuals would need. And what they did was they used 25-year-old, young, healthy, ideal weight, physically active males and fed them nothing but a dairy, high-quality dairy protein for seven days and looked at nitrogen balance. So they got a number, 0.8 grams per kg, which is very low, but probably only applies to physically active, healthy young 25-year-olds. And so I think it gives us sort of a basement number, but it has nothing to do with optimum health.

8:52And I was listening to the press conference, and Marty McCary was talking about how it was based on nitrogen balance and that we don't have any valuable health outcomes that we know of based on a nitrogen balance. Do you agree with that? Right. I mean, nitrogen balance is sort of an indicator for growth, which is where it really developed. It developed out of animal science is when an animal or a person is growing, they're gaining nitrogen. They're growing. They're gaining muscle mass. And so that's a meaningful number. But in a non-growing adult, it's not very meaningful. and I don't know of any health outcome that relates to it at all.

9:30One of the other things that I heard Kennedy mention was this idea of we're going to use rigorous science. So perhaps in the past, the old guidelines were not based on high quality evidence and what they were really trying to do is then think about health outcomes and then high quality data to support health outcomes, someone in a macronutrient, from a macronutrient perspective. Thank you to Timeline for sponsoring today's episode. As we step into the new year, we're all thinking about routines, what to start, what to stop, and what to finally commit to. But the body doesn't respond to resolutions.

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10:56Muscle is the organ of longevity, and without strong mitochondria, you can't have strong muscles. If staying forever strong is part of your plan, get 35 % off MitoPure subscription at timeline.com slash Dr. Lyon. Yeah, and I sort of understand the dilemma. The public would like nice, clean answers, and so the people in charge would like to give them that. But the problem is in nutrition, we don't have nice, clean answers. And I think the difference that Kennedy's looking at between hard science is that we would like to have what we call random control trials, where people are actually well-controlled, what they're eating is well-established, well -controlled.

11:42A lot of the nutrition right now is using what we call epidemiology, which is where you basically go out and ask someone what they ate yesterday and they give you some answer, probably make it up. And then 20 years later, you ask how their health turned out. And I, for one, don't remember what I ate yesterday. I don't remember what I ate this morning. And so I think the problem with it, in computer language, you always say garbage in, garbage out. If you start out with really bad food data, making conclusions from it 20 years later is not very good. So I think Kennedy is arguing that that's not the way we should do nutrition science.

12:23Back in the old days, epidemiology was good for something like smoking. You either smoked or you didn't. And 20 years later, you can say there was lung cancer. Okay, that's very clean. Nutrition is much more complicated than that. And so I think what Kennedy is saying is what we need to base our science on is well-controlled studies. And if we don't have well-controlled studies, we shouldn't make conclusive answers. And I think that's where we're at. And I think that's what the report reflects. The science that's used is pretty hard and fast. And places where we don't have an answer, we say we need more research.

12:58And I think that will ultimately help guide HHS and NIH in terms of the research they fund. The protein conversation, when you say you feel that the data was good, the data that was examined to inform these decisions, can you talk to me a little bit about what kind of data and what kind of science was used for the protein? I worked on one part of it. I worked on the protein part. Which is arguably the most important. As one might expect in this conversation. And so Heather Lighty from University of Texas in Austin, she and I went back and we had a relatively short period of time. We just started working on it in Argus.

13:38So what people do are, A, look for a lot of randomized control studies. How many can you find? They like to do systematic reviews to pull that all together. So we did a combination of systematic reviews and narrative reviews to pull it together, both in the topics of how much protein do we think is optimum for adults, and then also how much protein from a nutrient density standpoint. So we really looked at two main questions as we came to the conclusion about the protein data. You looked at how much protein was necessary for optimal health. How were you defining optimal health? That's a great question.

14:20And so there's a lot of different ways you could do it. Most people like what we would call more hard outcomes. So death or anthropometric measurements or whatever. So we actually used a lot of the weight management data. Since 75 % of adults are overweight, we thought that weight management was a good target. So we looked at things like changes in body weight, changes in body fat, changes in lean mass, and things like that as our main outcome measures. And what we found was that in basically all the studies out there, and there are quite a few, somewhere in the 40s, most of them, pretty much all of them, show one of those factors that the higher protein is a better outcome, Whether it's total weight management, weight loss, body fat loss, lean mass stability, all of those types of things.

15:15If someone were to argue and say, well, higher protein isn't good, because I've heard people, you know, there's somewhat of a plant-based community that really feels, and I use the word feels, that we're eating too much protein or we're already eating enough protein. I imagine that as someone who is part of the committee, there's going to be quite a bit of pushback. Yeah, I mean, I think one of the great things about the dietary guidelines and the way we've written them is we have allowed for those different opinions. We have tried to put the best science as to where we think the optimum target is.

15:52But we've then allowed for if someone is a vegetarian, what does this mean? What's the liability to that? What nutrients are they likely to be low on? So the idea that there's too much protein, there's a lot of research that has shown that higher levels are perfectly safe. Lower levels, we know that there's risk to it. And food choices may be even the bigger risk. We know that as people go toward lower protein diets, they tend to be more likely to be deficient in B12, B6, niacin, iron, zinc, selenium. So those data are pretty clear out there. So your protein food choices make a lot of difference to your overall diet quality and nutrient density.

16:41You mentioned a few nutrients of concern. So you mentioned B12, B6, niacin, zinc, selenium, and these are nutrients that are found in animal products more readily and also more bioavailable. Would you agree with that? Exactly. So they're at higher concentration. If you look at meats, for example, all of those are micronutrients that are exactly the same as we would have in our muscles. I mean, it's exactly the same role, the same metabolic role. So they're in the same concentration. And as you pointed out, they're all bioavailable. So iron might very well be in plants, but it's less than 10 % absorbed.

17:25And so bioavailability and also nutrient form are all big issues. And the animal products just provide more nutrient-dense foods. Do you anticipate, it highlights animal-based proteins, which is, again, extraordinary. Do you anticipate pushback on red meat? That seems to be a topic of conversation that has a resurgence every, I don't know, three months, three weeks, three days. Yeah, I think that there will be individuals and groups who think that's inappropriate, just like there are individuals like me and groups who think that the previous guidelines were inappropriate. I think what is important about these guidelines is they allow consumers to make choices.

18:24They provide the science and people can make their choice. Before they were kind of social prescriptive type of things that government knows best and you should follow what we tell you. I think the guideline should be this is what the science tells us and you are free to make choices. And I think that's a big difference. The protein has increased by 50 % to 100 % from 0.8 grams per kg now to 1.2 up to 1.6 grams per kg. Are you aware of any data that would suggest that the 0.8 number is more valuable for human health than, say, the higher number of protein? Yeah, that's actually part of the report that Dr.

19:08Leide and I put together is that we looked at that specifically comparing all of the RCT type of, you know, really rigorous research, comparing values of studies that used above 1.2 versus something around 0.8. And uniformly, the higher ones who are always better. Once in a while, there wasn't a statistical difference, but out of all of the studies we ever looked at, we never found a single one where the 0.8 was better on any outcome, whether it was things like inflammation and glutathione peroxidase or whether it's body composition or anything else. There's no studies that ever say that's a better choice.

19:52It's really important because, again, this landscape, while amazing because of the velocity at which information spreads is extraordinary, on the same hand, if someone has a large following with a lot of opinion, it can sway the population and also sway people's perspective as opposed to being a bit more objective in, say, the data. Yeah, I mean, my perspective on all of this is that I think what we want to do is empower consumers to make their personal choices. And unfortunately, the guidelines haven't really allowed that. Back to the original food guide pyramid, it's one size fits all. You do what we say and you're going to be healthier.

20:36And obviously, that was a miserable failure. We've got epidemics of obesity and diabetes. Heart disease really hasn't changed. We have 40 million people on statin drugs now. There's nothing about the guidelines that have worked. And so I think it's time to empower people to look at the science. We've tried to give them the science to think about, and they can then make their own decisions. And for me, what I look at and think about, what's the guideline that restricts animal products to a 10-year-old in school lunch? What's the logic behind that? Is that what was happening before? I know many of you fast forward through these ads.

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23:24So now we've changed that landscape. For the next five years. Hopefully longer than that, but, you know, at least till the next guidelines. It hasn't changed for the last, I don't know, what did you say, 40 or 50 years? Yeah, 1980, so 46 years. Okay. We're changing it. Hopefully people will see the benefit. We know the other pattern wasn't working. Again, I think these guidelines are very straightforward. I think they're very fair and reasonable. I think they will be harder to argue against. What does that look like in daily practice for someone? At least the protein. You know, what I hope people will learn is that when they think about their meal, when they think about their orientation to food, they should always think about a protein choice first.

24:19If you want to be vegetarian, that's a protein choice. If you want to be a carnivore, that's a... Or if you want to be in the middle, that's a protein choice. But once you make that, everything else has to line up. Your nutrients are now being determined by what that choice was. How many other fats or how much carbohydrates you're going to eat is all determined by that protein choice. And we've been doing it the other way around. We've been avoiding fat, using carbs, and we probably need some protein. We're basically flipping the script to protein choice first. Now, this is a spoiler alert, but you did write the nutrition chapter in the Forever Strong Playbook that's coming out January 27th.

24:59We did not plan this at all. I hounded you to write the nutrition chapter, and I would say that 90%, or would you, probably even more. It seems very reflective of implementation of the new guidelines. Yeah, it's... You haven't read the book. Hopefully more than a coincidence, but the research we did at the University of Illinois was based on basically what these new guidelines look like. And so part of what we based them on is the research that we did. We have firsthand knowledge of how these diets work, and we compared it to the old Food Guy Pyramid. We used that as our control, and we did it.

25:42And, you know, as you just pointed out in your new book, basically the diet is exactly how we planned it. You decide on your calories, you target your protein first, then you go to your vegetables and fruit, and finally you decide on what grains you can tolerate. And that's exactly how you plan it. And from a practical perspective, which we do cover in the book, the first meal we typically say is very important if it's between 30 and 50 grams of dietary protein. There's a reason as to why we believe that that is. It's the first meal. You're coming out of a catabolic state. The muscles are primed for nutrients.

26:20You want to stimulate them either through amino acids, i.e. protein, or physical activity. Did you teach me well? Yeah. And what that would look like is it could be a protein shake. It could be eggs. It now could be eggs and steak. Yeah. Amazing. There's many different choices. I always like to buffer that comment just a little bit is that it's more important the older you get. We don't define older. Yeah. When someone's young and growing, even into your 20s up to around 30, the meal distribution doesn't seem to make as much difference. It's more about how much protein for a total day. But as we get older, the body gets what we call anabolic resistance.

27:07We're a little less efficient with protein, and we think the amount per meal becomes more important. And our research shows that that first meal seems to be probably the most sensitive. When you say that the meal distribution, and there's a lot of controversy, and this isn't really actually related to the guidelines. This is more in the nuanced and in the weeds. People will say protein distribution doesn't matter as long as you're getting your overall protein. What would you say if someone is 55, getting 1.6 grams per kg, does it matter how they distribute their protein? I would say that the issues then become related to physical activity and overall health.

27:51You know, if someone is pretty physically active, they're going to the gym three days a week, they're doing some resistance training, two meals a day that exceed 35 grams of protein is probably fine, probably doesn't matter. The more stress they're under, if they're trying to lose weight or if they're taking a drug for weight loss, if they're bed fast, anything that puts them under stress, then I think that distribution becomes more and more important. So we used it during our weight loss studies, and we found it very effective to make that first meal a focal point. So again, perfectly healthy, physically active individual in their 50s probably doesn't make much difference.

28:34Are they better off having one massive protein meal or distributing through the day? I think there's quite a bit of research to suggest that your efficiency of use of protein at a meal probably tops out around 60 grams at a meal. So, you know, is an 8-ounce steak the optimum? You probably don't need a 16-ounce steak. So, you know, I think distribution, as you go to higher and more protein, I think having it in multiple meals probably makes sense. I want to pause on that for a second because it's that you guys might have tuned out, which I hope you didn't. But there is a component to distribution.