Living

Specific Recommendations for Healthy Living in the 21^st Century:

The 4 key elements of Healthy Living & Diet Advice | Building Blocks (Protein, Carb, Fat, Veges/ Fiber, Dairy, Water, Salt etc) |

(1) Healthy eating habits. Links: Examples of Healthy Choices & Snacks | Best Diet |

(2) Regular physical exercise. See Benefits of Exercise |

(3) Reduced stress.

(4) Adequate sleep.

All of the above helps us avoid obesity and live longer, healthier lives. “Weight-loss” and Fad Diets |

• People who meet more of the healthy goals recommended by the American Heart Association are less likely to die of cardiovascular causes according to data from the NHANES surveys with 15-year median follow-up (JAMA. Published online March 16, 2012)[Less than 2% of people reached all seven ideals, those who met six or seven goals had reduced risks for all-cause mortality (adjusted HR = 0.49), compared with participants meeting zero or one goal of: not smoking; moderate exercise at least 5 times a week; untreated blood pressure under 120/80; HbA1c under 5.7%; total cholesterol under 200 mg/dL; BMI less than 25; a diet high in produce, fish, and whole grains, and low in sodium and sugary beverages].

• Many small lifestyle choices an adult can make–such as individual food choices, quantity of sleep, alcohol intake, and even TV-watching habits–can each contribute to or attenuate, often in surprising ways, the gradual weight gain many people experience starting in their middle years, suggests an analysis of a study that followed some 120,000 nonobese U.S. health professionals, evaluating self-reported changes in diet, lifestyle, and weight every 4 years for at least 12 years (most were followed for 20) found that the average weight gain was 3.4 lb for each 4-year period (NEJM 2011;364:2392-2404)……..Dietary factors leading to the most weight gain included increased consumption of potatoes, sugar-sweetened beverages, and meats…..Weight loss was associated with increased consumption of vegetables, whole grains, fruits, nuts, and yogurt……Increased physical activity (as opposed to absolute levels of activity) was also associated with weight loss….no significant differences were seen for low-fat and skim milk vs whole-fat milk.”

• Successful weight loss can be achieved with either a low-fat (1200 to 1800 kcal/d; =30% calories from fat) or low-carbohydrate diet (20 g/d for 3 months then 5 g/d) when coupled with behavioral treatment according to a study on 307 women and men (mean age, 45.5) (Ann Internal Med 2010;153:147-157)…..During the first 6 months, the low-carbohydrate diet group had greater reductions in diastolic blood pressure, triglyceride levels, and very-low-density lipoprotein cholesterol levels, lesser reductions in low-density lipoprotein cholesterol levels, and more adverse symptoms than did the low-fat diet group. The low-carbohydrate diet group had greater increases in high-density lipoprotein cholesterol levels at all time points, approximating a 23% increase at 2 years……..Ultimately, most patients, need an ELF (eat less food) diet.

• Living close to supermarkets and grocery stores did not mean that urban dwellers ate more fruits and vegetables or had a healthier overall diet according to data from 5,000 young adults living in four cities: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota and Oakland, California(Arch Intern Med 2011;July 13)……But having more fast-food restaurants nearby did mean that low-income men ate at the chain restaurants more often……suggest community gardens as a non-traditional example of a way to promote healthy eating and bring people together.

• Menu labels on college cafeteria food — highlighting the good and the bad of various meal options — make no difference in students’ choices, a study concludes (Am J Clin Nutr 2011;June 15th).

• A third of U.S. high school students do not eat vegetables each day and more than a fourth do not always have a daily serving of fruit (MMWR 2011;November 23rd).

• A mechanistic study comparing three different eating patterns–a low-fat diet, a low-glycemic-index diet, and a low-carbohydrate diet–has found that participants used up the most energy with the last, but there were metabolic disadvantages to this approach according to a three-way crossover study (JAMA 2012; 307:2627-2634)….Those on the low-carb diet burned 350 calories per day more than those on the low-fat one, even though they consumed the same amount of calories on all these diets…but, with the low-carb diet, the researchers observed increases in CRP, a measure of chronic inflammation, and 24-hour cortisol, the key stress hormone, “suggesting that any initial advantages were eroded over time by these biological stressors.”…..The findings reinforce the message that a low-glycemic-index diet is best for weight loss and cardiovascular disease prevention and illustrate a novel concept–that not all calories are alike from a metabolic perspective as extreme restriction of fat or carbs can have bad effects.

— The best long-term approach will be to avoid restriction of any major nutrient–either fat or carbohydrate–and instead focus on the quality of nutrients. “Relatively unprocessed, low-glycemic-index foods are best……cut back on white bread, white rice, potato products, prepared breakfast cereals, and, of course, concentrated sugars.”

— The argument that the food industry likes to make–that all foods can be part of a healthful diet as long as you watch calories may be misleading at best.

Building Blocks of a 21^st Century “Healthy” Living Diet:

This is simply an outline of what to eat each day based on basic dietary guidelines, not a rigid or structured plan. Adherence to diet for one year, not the specific diet plan (Atkins, Ornish, Weight Watchers, or Zone), is the most important determinant of weight loss and reduction of cardiovascular risk, according to a RCT with 160 pt’s (JAMA. 2005;293:43-53)…..recommends the “low fad” approach as one way to improve dietary adherence rates is to use a broad spectrum of diet options to better match individual pt food preferences, lifestyles, and cardiovascular risk profiles. Physicians now emphasize a heart-smart diet, life-long, similar to the 2005 USDA food pyramid. Most importantly we now emphasize exercise (daily or at least 20min 3x per week). Learning to read the labels can be helpful, this will give you a general idea about the foods you commonly eat and allow you to make modifications based on the information below. Who should be following these lifestyle and dietary guidelines?: most any and every healthy person from age 2 to 99+ years old including diabetics, and those with cardiac disease or HTN. These guidelines are designed for the primary (before the disease) and secondary (after the disease) prevention of the diseases that kill the majority of Westerner’s (cardiac and cancer). There will be slight modifications for those who are pregnant, have liver, kidney disease or other less common diseases.

The 5 key healthy lifestyle Factors: 5 fruits and vegetables/day, regular exercise >12 times/month, maintaining healthy weight [body mass index 18.5-29.9 kg/m2], moderate alcohol consumption [up to 1 drink/day for women, 2/day for men] and not smoking.

• Five lifestyle factors had individual and combined effects on risk for all-cause, CV, and cancer mortality according to data from the Nurses’ Health Study (BMJ 2008;337:a1440)…..25%r of cancer deaths and one third of CV deaths were attributable to smoking…….Obese women (BMI, >30 kg/m2) were almost 3 times as likely to die of CV causes than were women whose BMIs were lower (18.5–24.9); women who exercised 5.5 hours per week were 50% as likely to die of CV disease as were women who were less active…..Overall, 72% of CV mortality, 44% of cancer mortality, and 55% of all-cause mortality were attributable to having any of four risk factors: being overweight, smoking cigarettes, not engaging in physical activity, and having a low healthy-diet score……Having all four risk factors raised CV mortality risk sevenfold, more than doubled cancer mortality risk, and more than tripled all-cause mortality risk…….Compared with alcohol abstinence, light-to-moderate alcohol consumption (up to 1 drink daily) was associated with lower CV mortality risk and, in general, was associated with lower risk for all-cause mortality.

• A study on 20,000 men and women (age range, 40–79) found that during an average follow-up of 11.5 years that compared with people who engaged in all four health-related behaviors (not smoking, regular physical activity, moderate alcohol intake (1–14 drinks weekly), and high fruit and vegetable intake [based on high plasma vitamin C levels])(and adjusted for numerous demographic and clinical variables), the relative risk for stroke was nonsignificantly higher for people who engaged in three behaviors (RR, 1.2) and significantly higher for those who engaged in two behaviors (RR, 1.6), one behavior (RR, 2.2), and none of the behaviors (RR, 2.3)(EPIC Norfolk study. BMJ 2009;338:b349)…..Results were similar when stratified by age, sex, BMI, and social class.

• Data from NHANES III (2006) finds that generally, adherence to a healthy lifestyle pattern in adults aged 40-74 years has decreased during the last 18 years, with decreases documented in 3 of 5 healthy lifestyle habits (Am J Med 2009;122:528-534)….BMI has increased from 28% to 36%; physical activity 12 times a month or more has decreased from 53% to 43%; smoking rates have not changed (26.9% to 26.1%); eating 5 or more fruits and vegetables a day has decreased from 42% to 26%, and moderate alcohol use has increased from 40% to 51%…..Adherence to all 5 healthy habits has gone from 15% to 8%. Lifestyle choices are associated with the risk of cardiovascular disease and mortality from all causes (JAMA. 2004;291:1238–1245).

• The benefits are not confined to lifelong practitioners of healthy lifestyle habits; recent studies have demonstrated that middle-aged adults who switch to a healthy lifestyle after age 45 years can reduce cardiovascular events by 35% in only 4 years (Am J Med. 2007;120:598–603).

• To examine whether wealth is a factor in this disparity, researchers compared the health and socioeconomic status of 9900 U.S., 6500 British, and 17,000 mainland European adults (age range, 50–74) found that Americans had a higher prevalence of all evaluated health conditions than Britons or mainland Europeans. For example, rates of heart disease and cancer were higher among Americans (18% and 11%, respectively) than among Britons (12% and 6%) and mainland Europeans (11% and 5%) (Am J Public Health 2009;99:540)……In all disease categories except cancer, poorer people in all countries reported worse health than wealthier people; however, the disparities between poor and wealthy people were much greater in the U.S. than in Europe.

• An 8-year study in Germany with 23,000 adults aged 35 to 65 found that the more healthy lifestyle behaviors that adults follow, the lower their risk for a number of chronic conditions (Arch Intern Med. 2009;169(15):1355-1362)……never smoking, having a BMI <30, exercising regularly, and adhering to a healthy diet (high in fruits, vegetables, and whole grains, and low in red meat)……….adults with one healthy behavior saw a 50% reduction in risk — and those with all four behaviors saw nearly an 80% reduction — compared with those with no healthy behaviors.

• The consumption of fruits and vegetables increased among nations with a higher gross domestic product (GDP) and wealth index, but this was offset by an increase in the amount of energy obtained from total and saturated fats, as well as from protein that has increased almost linearly with increasing incomes (Lancet 2011; 378:1231-1243)….they describes an “epidemiological transition,” might help shift global food policies so that countries subsidize the production of fruits and vegetables rather than meat and dairy. In addition, the study highlights an insufficient policy approach when it comes to increasing physical-activity levels…. Based on data from the INTERHEART and INTERSTROKE studies, approximately 50% to 60% of the risk of cardiovascular disease is attributable to modifiable lifestyle factors.

Eat lots of whole grains, vegetables, fruits, beans along with “healthy” forms of carbohydrates, fats and protein. Eat a variety of foods. Don’t try to fill your nutrient requirements by eating the same foods day in, day out. It’s not a rigid prescription but a general guide that lets you choose a healthful diet that’s right for you. Emphasizes weight control through exercising daily (physical activity is at the center of the pyramid, minimum of 30 minutes daily) and avoiding an excessive total intake of calories. Vegetables and fruits should also be eaten in abundance (unlimited allowance)..aim for 10 whole, fresh fruits and 10 different vegetables a day. The bulk of one’s diet should consist of healthy fats (liquid vegetable oils such as olive, canola, soy, corn, sunflower and peanut) and healthy carbohydrates (whole grain foods such as whole wheat bread, oatmeal and brown rice). If the source is “healthy”, you do not have to worry too much about the percentages of total calories coming from each. Moderate amounts of healthy sources of protein (nuts, legumes, fish, poultry and eggs) are encouraged, but dairy consumption should be limited to one to two servings a day. Minimize the consumption of red meat, butter, sugar and excessive amounts of refined grains (white bread, white rice and white pasta). Trans fat has no place in a healthy diet. A multiple vitamin is optional, but recommended if any long-term diseases or extremes of age. A good nutritional diet is not so much about good food and bad food, but what the overall diet is like. If trying to lose weight, aim for 1 hour of physical activity each day and eat a large vegetable salad first for lunch and first for dinner…eat out less frequently…snack on fresh fruit and raw nuts…eat until your satisfied, not stuffed.

Bottom Line: Most physicians endorse a long-term balanced diet and exercise approach rather than endorsing either low-carb or low-fat diets. Don’t worry about specific recipes or strict diets, use common sense. See “Weight-loss” and Fad Diets |

Does it take effort to learn the principles of health and fitness and apply these principles to your own daily life? In the long run, it takes way more effort to live with the disability from a crippling heart attack or stroke, or the loss of a leg due to diabetes. What you going to do today (self-discipline, sacrifice, and the change), not tomorrow or the next day will start the process of cleaning up those arteries and remove that extra (toxic) abdominal fat you might be carrying. Instead of trying to change all bad food habits at once, try changing one or two habits at a time. Be sensible, eat whatever you want on special occasions such as Christmas, Thanksgiving, and birthdays. Eat impeccably 90% of the time and the rest of the time—don’t worry about it.

To attenuate the increase in glucose, triglycerides, and inflammation after a meal, the authors (J Am Coll Cardiol. 2008;51:249-255) recommend a diet rich in minimally processed, high-fiber, plant-based foods, including vegetables and fruits, whole grains, legumes, and nuts. Other dietary interventions that can significantly ameliorate postprandial dysmetabolism include intake of lean protein, vinegar, fish oil, tea, and cinnamon. Additional benefits may result from calorie restriction, weight loss, exercise, and low-dose to moderate-dose alcohol….Select high-fiber carbohydrates with low glycemic index, including vegetables, fruits, whole grains, legumes, and nuts at all 3 meals, consume lean protein.

Specific recommendations to improve postprandial glucose and triglycerides are as follows:

Select high-fiber carbohydrates with low glycemic index, including vegetables, fruits, whole grains, legumes, and nuts.

At all 3 meals, consume lean protein.

Eat approximately 1 handful of nuts daily (using a closed fist), consumed with vegetables, grains, berries, or other fruits.

Eat salad daily, consisting of leafy greens with dressing of vinegar and virgin olive oil.

Avoid highly processed foods and beverages, particularly those containing sugar, high-fructose corn syrup, white flour, or trans fats.

Limit portion sizes to modest quantities.

Maintain normal weight and avoid overweight or obesity. Waist circumference should be less than one half of height in inches.

Perform physical activity for at least 30 minutes or more daily, of at least moderate intensity.

For those with no history of substance abuse, consuming 1 alcoholic beverage before or with an evening meal may be considered.

“Experimental and epidemiological studies indicate that eating patterns, such as the traditional Mediterranean or Okinawan diets, that incorporate these types of foods and beverages reduce inflammation and cardiovascular risk,” the review authors write. “This anti-inflammatory diet should be considered for the primary and secondary prevention of coronary artery disease and diabetes.”

Ideal Diet is Individualized: See Carb’s and Glycemic Index |

Focus on low-energy-dense foods: (see diet and obesity) The energy density of a food refers to the calories in a given amount of food. Foods with high-energy density contain a large number of calories in a relatively small amount of food. High-energy density foods often contain a high amount of fat or sugar. Fresh vegetables, fruits and whole grain carbohydrates such as pasta and brown rice occupy a large volume, take a relatively longer time to eat and lead to a lower overall calorie intake. Combining these with healthy sources of fat and protein in conjunction with regular exercise promotes weight loss and you still feel satisfied. The goal is to have the best overall healthy today and in the future, not just weight loss.

Dietary Protein:

All foods made from meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds are considered part of the Protein Foods Group. A healthful diet should provide 10% to 15% of its calories from protein. The thousands of proteins in the human body are synthesized from just 21 amino acids. Most amino acids can be synthesized endogenously, but nine cannot. Unlike reserves of fat (stored in large amounts as triglyceride in adipose tissue) and reserves of carbs (stored in small amounts as glycogen in liver and muscle), there are no endogenous reserves of amino acids or protein; all the proteins in the body are serving a structural or metabolic function. As a result, bodily function can be impaired if proteins are catabolized because of energy deficiency, wasting diseases, or dietary protein intake that is not sufficient to replace protein losses.

The protein digestibility–corrected amino acid score (PDCAAS): compares the amino acid composition of a protein with human amino acid requirements and corrects for digestibility. If a food protein’s limiting amino acid is 70 percent of the amount found in the reference protein, it receives a score of 70. The amino acid score is multiplied by the food’s protein digestibility percentage to determine the PDCAAS.

Selected foods: 1.0 is the maximum PDCAAS a food protein can receive. Casein (milk protein) 1.00. Egg white 1.00. Soybean (isolate) .99. Beef .92. Pea fl our .69. Kidney beans (canned) .68. Chickpeas (canned) .66. Pinto beans (canned) .66. Rolled oats .57. Lentils (canned) .52. Peanut meal .52. Whole wheat .40.

The biological value (BV) of a protein: measures its efficiency in supporting the body’s needs.

Selected Foods: Egg 100 (max). Milk 93. Beef 75. Fish 75. Corn 72.

The 2011 USA Diet guidelines suggest that one selects a variety of protein foods to improve nutrient intake and health benefits, including at least 8 ounces of cooked seafood per week. Young children need less, depending on their age and calories needs. The advice to consume seafood does not apply to vegetarians. Vegetarian options in the Protein Foods Group include beans and peas, processed soy products, and nuts and seeds. Meat and poultry choices should be lean or low-fat.

Some commonly eaten choices in the Protein Foods Group, with selection tips, are:

Meats*:

Lean cuts of: beef, ham, lamb, pork, veal.

Game meats: bison, rabbit, venison.

Lean ground meats: beef, pork, lamb.

Lean luncheon or deli meats

Organ meats: liver, giblets.

Poultry*: chicken, duck, goose, turkey, ground chicken and turkey.

Eggs*: chicken eggs, duck eggs.

Beans and peas: black beans, black-eyed peas, chickpeas (garbanzo beans), falafel, kidney beans, lentils, lima beans (mature), navy beans, pinto beans, soy beans, split peas.

Processed soy products: tofu (bean curd made from soybeans), white beans, bean burgers, veggie burgers, tempeh, texturized vegetable protein (TVP).

Nuts and seeds*: almonds, cashews, hazelnuts (filberts), mixed nuts, peanuts, peanut butter, pecans, pistachios, pumpkin seeds, sesame seeds, sunflower seeds, walnuts. See Nuts, Legumes & Herbs |

Seafood*:

Finfish such as: catfish, cod, flounder, haddock, halibut, herring, mackerel, Pollock, porgy, salmon, sea bass, snapper, swordfish, trout, tuna.

Shellfish such as: clams, crab, crayfish, lobster, mussels, octopus, oysters, scallops, squid (calamari), shrimp.

Canned fish such as: anchovies, clams, tuna, sardines.

*Selection Tips: Choose lean or low-fat meat and poultry. If higher fat choices are made, such as regular ground beef (75 to 80% lean) or chicken with skin, the fat counts against your maximum limit for empty calories (calories from solid fats or added sugars). If solid fat is added in cooking, such as frying chicken in shortening or frying eggs in butter or stick margarine, this also counts against your maximum limit for empty calories (calories from solid fats and added sugars). Select some seafood that is rich in omega-3 fatty acids, such as salmon, trout, sardines, anchovies, herring, Pacific oysters, and Atlantic and Pacific mackerel. Processed meats such as ham, sausage, frankfurters, and luncheon or deli meats have added sodium. Check the Nutrition Facts label to help limit sodium intake. Fresh chicken, turkey, and pork that have been enhanced with a salt-containing solution also have added sodium. Check the product label for statements such as “self-basting” or “contains up to __% of __”, which mean that a sodium-containing solution has been added to the product. Choose unsalted nuts and seeds to keep sodium intake low.

Vegetarian diet: this can supply all the needed protein, but that is beyond the scope of this text. Suffice it to say that large mammals such as elephants / cows / horses / apes / giraffes ect don’t eat cows, pigs, chickens, turkeys, eggs, milk, cheese, or fish to get their protein to grow big, powerful muscles and to boost their energy. These mammals eat plant foods only.

Protein content of plants: Spinach: 49%. Broccoli: 33%. Cauliflower: 26%. Romaine lettuce: 36%. Corn: 11%. Kale: 22%. Cucumber: 24%. Potato: 11%. Oranges: 8%. Carrot: 10%. Cantaloupe: 9%. Grapefruit: 8%. Berries: 7%. Tomato: 16%. Almonds: 13%. Pumpkin seeds: 17%. Brown Rice: 8%. Oats: 15%. Kidney beans: 26%. How much protein do we need. Rapidly growing babies only require 4.5% to 5% protein (the amount in mother’s milk).

Typical healthy diet: we emphasize high animal protein foods from natural sources, such as fresh meat, fish, and poultry. Poultry and fish contain less saturated fat and more unsaturated fat than red meat does. Fish is a rich source of the essential omega-3 fatty acids. Avoid processed meats and fish though, as they are high in sodium and harmful preservatives and additives. Also, choose leaner cuts of meat and poultry, since most cattle and chickens are fattened with grains and soybeans, giving them a less healthy fatty acid profile. Best to stick with skinless chicken breast, turkey breast, lean ground turkey, swordfish, haddock, salmon, tuna, crab, lobster, shrimp, top round steak, top sirloin steak, lean ground beef, buffalo, lean ham, egg whites or substitutes, low-fat cottage cheese. Modern beef cattle, pigs, lamb and poultry found in most supermarkets were raised and fattened on corn, wheat and soybeans (all oil seed crops), this alters their natural fat ratios to less omega-3 to more saturated fat. Best to choose cuts with the words “round” or “loin” as they are usually lean. If you crave red meat, currently one of the best options is a bison burger, a slab of grass-fed bison meat, as it has a healthier mix of fats than even the leanest beef.

Dietary Sources of Protein:

Serving Size (1 cup) –Protein Content (g) -Calories -Calories from Protein (%)

Legumes (beans): Black-eyed peas. Chick peas. Garbanzo beans. Kidney beans. Lentils. Lima beans. Pinto beans. Soybeans, including tofu (omit one fat exchange). Split peas. Other dried beans and peas. 1 cup has a protein content of ~20g, 230 calories, 30% calories from protein. Legumes (beans): are among the oldest cultivated plants. Legumes are second only to grains in supplying calories and protein to the world’s population. Compared with grains, they supply about the same number of total calories, but usually provide 2–4 times as much protein.

Broccoli: 1 cup has a protein content of ~4g, 40 calories, 40% calories from protein.

Corn / Carrot / Tomato: 1 cup has a protein content of ~3g, 50 calories, 15% calories from protein.

Fruits: (Apple, Banana, Orange, Pear, Strawberries) 1 cup has a protein content of ~1g, 80 calories, 6% calories from protein.

Grain products: (Barley, Pasta, Rice, Coffee cake, Bran muffin, Bread) 1 cup has a protein content of ~5g, 230 calories, 10% calories from protein.

Skim Milk: 1 cup has a protein content of ~8g, 85 calories, 38% calories from protein.

Whole Milk: 1 cup has a protein content of ~8g, 150 calories, 21% calories from protein.

Yogurt (low-fat): 1 cup has a protein content of ~12g, 145 calories, 33% calories from protein.

Cheddar cheese: 1 cup has a protein content of ~4g, 70 calories, 23% calories from protein.

Cottage cheese: 1 cup has a protein content of ~28g, 235 calories, 48% calories from protein.

Egg : 1 cup has a protein content of ~6g, 50 calories, 30% calories from protein.

Tuna: (water-packed) 1 cup has a protein content of ~60g, 270 calories, 89% calories from protein.

Meat: (Steak, Pork, Veal, Hamburger, chicken) 1 cup has a protein content of ~48g, 400 calories, 45% calories from protein.

Wild game contains 2-4% fat by weight compared to 20-25% of grain-fed domestic meats. If possible, eat wild game such as wild elk, deer, game birds, antelope and grass-fed steers as they have healthful fats (mono-unsaturated, polyunsaturated, omega 3 fats) and a lower – and therefore healthier – ratio of omega-6 (saturated fat) to omega-3 fatty acids in muscle meats, compared to grain-fed beef. Omega-3 oils prevent clotting if taken twice a week, aim for 4oz (about the size of a deck of cards). Broil, roast, or boil these foods instead of frying them. One may obtain all the protein from non-animal sources (soy, beans etc) as well. The FDA cautions pregnant women, nursing mothers, young children and women of childbearing age to limit their intake of tuna and other fish and shellfish to 12 ounces a week. Mercury levels in tuna can vary: fresh tuna steaks, for example, have higher mercury levels than canned light tuna. Women can safely eat tuna on a weekly basis, but those at risk should eat no more than 6 ounces a week.

Species	Fat %	Protein %	Cholesterol (mg/100g)
Beef	6.5	22	72
Lamb	5.7	20.8	66
Buffalo	1.9	21.7	62
White tail Deer	1.4	23.6	116
Mule Deer	1.3	23.7	107
Elk	0.9	22.8	67
Moose	0.5	22.1	71

*From the North Dakota State Univ.

All proteins in human cells are continuously catabolized and resynthesized. In a healthy 70 kg adult, about 280 g of protein is degraded and replaced daily. In addition, about 30 g of protein is lost externally through the urine (urea), feces, and skin. In healthy adults, daily protein losses can be fully replaced by as little as 0.4 g/kg. Because not all dietary proteins are fully digestible, the recommended dietary allowance (RDA) of protein for healthy adults is 0.8 g/kg. People who exercise strenuously on a regular basis may benefit from extra protein to maintain muscle mass; a daily intake of about 1 g/kg has been recommended for athletes. Women who are pregnant or lactating require up to 30 g/day in addition to their basal requirements. To support growth, children should consume 2 g/kg/day.

Protein intake: the goal is to match the rate of protein catabolism in the individual pt. Protein intake can be estimated by using the following generalized predictions for normal and hypercatabolic pt’s:

Daily protein intake with normal metabolism –> 0.8-1 g/kg.

Hypercatabolism –> 1.2 to 1.6 g/kg. A more accurate assessment of daily protein requirements requires some measure of protein catabolism via urinary excretion of nitrogen.

Subset Elevation: Albumin: dehydration.

a-1: neoplastic diseases, inflammation.

a-2: neoplasms, inflammation, infection, nephrotic syndrome.

b: hypothyroidism, biliary cirrhosis, diabetes mellitus.

g: see immunoglobulins in allergy chapter.

Subsets decreased: Albumin: malnutrition, chronic liver disease, malabsorption, nephrotic syndrome, burns, systemic lupus erythematosus. a-1: emphysema (a-1 antitrypsin deficiency), nephrosis. a-2: hemolytic anemia’s (decreased haptoglobin), severe hepatocellular damage. b: hypercholesterolemia, nephrosis.

Info: Reducing individual meat consumption by 10% may reduce greenhouse gas emissions (Lancet. 2007;Published online September 13)…..Agricultural activity, notably livestock production, accounts for approximately one fifth (22%) of total greenhouse gas emissions, which is a similar contribution to that of industry and greater than that of transport…..Nearly 80% of the agricultural sector’s emissions are caused by livestock production, including transport of livestock and feed. Methane and nitrous oxide, both closely associated with livestock production.

Red-meat intake was linked with shortened longevity, but confounding by unmeasured risk factors might partly explain this finding (as mortality from injuries and suicides was highest among those at the top quintile of red-meat consumption) according to a study in which a half-million Americans (age range, 50–71) completed baseline food frequency questionnaires and were followed for 10 years (Arch Intern Med 2009;169:562)…..the authors calculated that 11% of premature deaths in men and 16% of premature deaths in women could be prevented if people reduced red-meat intake….Intakes of red, white, and processed meats were categorized into quintiles……10-year risks for total mortality, cancer mortality, and cardiovascular mortality were greater among people in the highest quintile of red-meat intake than among those in the lowest (hazard ratios, 1.31, 1.22, and 1.27, respectively)……Similar trends (but lower HRs) were seen for processed meat intake.

• High intake of red and processed meats is associated with increased risk for death in older adults, while white meat may have a protective effect according to data from a half million adults aged 50 to 71 completed food-frequency questionnaires and then were followed for 10 years(Arch Intern Med. 2009;169(6):562-571).

• A study showed that carnitine in red meat was broken down by bacteria in the gut down into a gas, which was converted in the liver to a chemical called trimethylamine N-oxide (TMAO) which is likely the cause of the higher levels of cholesterol and an increased risk of heart disease (Nature Medicine. 2013;Published online April 7)…..the UK government recommends eating no more than 70g of red or processed meat a day – the equivalent of two slices of bacon.

Processed meat: In a meta-analysis of observational data, consumption of processed meat conferred higher risks for coronary heart disease and diabetes than consumption of unprocessed red meat (Circulation 2010;121:2271)…..Consumption of processed meat was associated with a 42% increase in risk for CHD (5 studies; RR, 1.42 per 50-g serving/day; 95% CI, 1.07–1.89) and a 19% increase in risk for diabetes (7 studies; RR, 1.19; 95% CI, 1.11–1.27)….Neither type of meat was associated with an elevated risk for stroke. But eating 50 g (<2-oz) of processed meat per day–the equivalent of one typical hot dog in the US, or two slices of deli meat–was associated with a 42% higher risk of CHD and a 19% increased risk of diabetes (Circulation 2010;published online May 17)…..red meats and processed meats had similar amounts of saturated fat and cholesterol, but processed meats had about four times the amount of sodium and 50% more preservatives, such as nitrates, than the unprocessed red meat…..”suggest that salt and other preservatives might explain this higher risk we found for processed meats.”….After multivariate adjustment, red-meat intake of 100 g per day–defined as unprocessed beef, pork, or lamb–was not associated with CHD (four studies) or diabetes mellitus (five studies).

• High consumption of processed meat (bacon, sausage, and ham etc) by middle-aged adults was associated with a near doubling of the risk of all-cause mortality, compared with low consumption, over a mean of 12 years……Risk of cardiovascular death was increased by more than 70% among people eating more than 160 g/day, as compared with those eating 10 to 19.9 g/day….Risk of cancer deaths was also 43% higher among the highest consumers of processed meats (BMC Med 2013; online March 5).

List examples of foods that contain 10 g of protein:

• 50 g of grilled fish

• 2 cups of cooked pasta

• 35 g of lean beef

• 2 cups of brown rice

• 40 g of turkey

• 3/4 cup of cooked kidney beans

• 2 small eggs

• 120 g of soybeans

• 300 ml of skim milk

• 60 g of nuts

• 3 cups of wheat flake cereal

Serum protein normal range: 6-8 g/dl (60-80 g/L) [CF: 10; SMI: 1 g/L]. Proteins other than albumin are best quantified by serum protein electrophoresis. The acute-phase reaction, as seen in early infection, often leads to decreased albumin and increased alpha-2 -macroglobulin. Chronic inflammation, which can be seen with chronic infections, collagen vascular d/o’s, and chronic liver disease, produces slightly decreased albumin with elevated gamma-globulin and modestly elevated

It is elevated in dehydration, multiple myeloma, plasmacytoma, Waldenström’s macroglobulinemia, sarcoidosis, collagen-vascular dz (check SPEP, UPEP, BM Bx, Ig subclasses).

It is decreased in malnutrition, low-protein diet, overhydration, malabsorption, pregnancy, severe burns, neoplasms, chronic diseases, cirrhosis, nephrosis.