DEFINING A HEALTHY DIET: PART 4 - PROTEIN HEAVY DIETS

This article forms part 4 of a health and wellness series on diet.

Part 1 discusses dietary guidelines and components.

Part 2-5 reviews 24 popular diet plans across 7 major dietary categories.

Part 6 concludes the review with the debunking of common dietary myths and a summary of the key findings.

Protein-Heavy Diets

While a high protein diet may not be necessarily unhealthy, it is extremely dangerous when not balanced with other dietary nutrients. Proteins are energetically inefficient (takes more energy to make use of them than they offer) but are required in moderation for facilitating optimal nutrition, energy metabolism and many other vital processes.

Animal proteins and a few very complex proteins found in plants are known to be similar to proteins found in our own cells on a molecular level. If the mucosal lining of the gut and the gut microbiome are impaired, protein digestion becomes hampered and undigested proteins are more likely to trigger immune reactivity and inflammation at various sites of the gut. A diet high in protein further promotes intestinal damage due to the toxins released by excessive protein fermentation.^[1] This may contribute to worsening the condition of those with autoimmune, gut and metabolic issues until digestive function is sufficiently restored.

Furthermore, those with gout, atherosclerosis, diabetes and kidney disease,^[2] may be prone to contracting kidney damage from consuming a diet too high in protein due to the increased load on kidney function. Individuals at a high risk of contracting these diseases may also have trouble with consuming a high protein diet. Healthy individuals are not likely to suffer any kidney problems from consuming lots of protein, as evidenced by available data.^{[3] [4]}

Nevertheless proteins are essential and promote health when consumed within the context of a varied healthful diet. A low to moderate protein diet is considered healthiest, provided the intake of protein is sufficient to meet one’s nutritional needs. A very low protein diet is likely to cause severe malnutrition and muscle wasting diseases.

13. Dukan Diet

The Dukan Diet was developed by Pierre Dukan, a self-proclaimed nutritionist and former doctor. It is exceedingly high in protein with very minimal carb, fat, fiber and micronutrient intake.^[5] Dukan designed the diet as a rapid weight loss strategy, founded on the observations that high protein consumption reduces body weight.

This diet plan became very popular in France, however was soon revealed to be highly prone to promoting a number of health problems. Those who currently follow this diet plan are likely to be motivated by weight loss and uninformed about optimal nutrition. While the diet does seem to reduce weight, it is regarded as one of the most dangerous commercial diet plans to follow.

Advantages

The only known advantage of this diet is that it initiates rapid weight loss^[6].

Disadvantages

This diet has received a lot of negative critique and much evidence is lacking that warrants its use for health promotion. The limited trials conducted on the Dukan diet yield negative results that point towards an increased risk of disease.

General disadvantages include:

• Easy to carry out in a way that is detrimental to health.
• May promote kidney stone formation and urinary issues.^[7]
• Appears to encourage malnutrition, unbalanced cholesterol levels and inflammatory immune activity.^[8] These results remained even when in the final phase of the diet, which attempts to “normalize” the participant.
• Has been associated with fatigue, nausea and ketoacidosis (which may induce a coma if sustained for long enough).^[9]
• Lacks fiber and may therefore harm gut health through lowering probiotic diversity.
• Not suitable for those with kidney disease, arthritis (especially gout), liver disease or severe digestive issues including IBS and celiac disease.
• Not recommended for those with cancer.

High Fat Diets

Most diets high in fat are typically very low in carbohydrates and low to moderate in protein.

In the body, carbohydrates contain a wide variety of sugars that are eventually converted into glucose. Glucose is then either used for energy production or stored. Greatly reducing the intake of carbohydrates and increasing fat intake promotes the body to generate energy from ketones, a chemical product of fat burning. This is the aim of all diets very high in fat, known as ketogenic diets.

14. Ketogenic Diet

A ketogenic diet is an extremely high fat diet that intends to cause a rapid shift in energy metabolism. Glucose is traded for fat burning at the cellular level, being transformed into ketone bodies which serve as an alternative substrate for mitochondrial energy production.^[10]

There are many different formats of the ketogenic diet, yet the general principle restricts carbohydrates to less than 50g per day (5-10% of intake), as well as limiting protein intake (10-20%). Fat is typically unrestricted and can make up anywhere between 70-80% of the diet. Due to the very extreme nature of this diet, it is vital to ensure that daily nutritional needs are met with a high variety of unrefined wholefoods consumed.

The diet was originally shown to reduce the risk of seizures in those with epilepsy and has since gained popularity as a weight loss plan. It should be noted that this is not an appropriate diet for anyone without appropriate expert supervision and advice. It is not advisable to follow the diet for longer than 6-12months.^[11]

Advantages

The conventional ketogenic diet may pose the following advantages:

• May serve as an additional energy source for endurance sports that helps to spare and make efficient use of stored muscle glucose (glycogen).
• Generally a high adherence rate.
• May improve health outcomes for certain neurological disorders including epilepsy, dementia and traumatic brain injury.
• Potentially lowers markers of insulin resistance, high blood pressure and triglycerides.
• Preliminary evidence suggests it may decrease the risk of metabolic diseases, hypertension, and polycystic ovary syndrome.^[12]
• Can decrease the risk of seizure onset in epileptics.
• May promote an increase in cellular antioxidant production.^[13]

Disadvantages

A ketogenic diet is contraindicated for those with liver disease, kidney disease, fat malabsorption issues, protein malnutrition and other digestive disorders. Diabetics that are on hypoglycemic medications should have their medical protocol adjusted appropriately before attempting a ketogenic diet.

Other disadvantages include:

• High risk of contracting ketoacidosis, suffering dehydration or electrolyte disturbances requiring hospitalization and hypoglycemia.
• Short term side effects could include nausea, vomiting, headache, insomnia, fatigue, dizziness, constipation and a lower tolerance for exercise. This is known as “keto flu”.
• May increase the risk of nutritional deficiencies, kidney stone formation, osteoporosis and gout.
• Increases fat oxidation^[14] which may detract from health if not coupled with exercise or enough physical activity to sustain increased fat consumption.
• Ketone bodies increase bad breath and also make many alcohol breath tests unreliable.
• Easy to follow in an unhealthy manner through consumption of unhealthy fats and thus may promote the risk of cardiovascular disease.
• Increases total cholesterol levels.
• Evidence supporting its efficacy in improving outcomes for metabolic diseases and other conditions^[15] is low, requiring further inquiry.

A Word on Ketone Supplements

In spite of potential health concerns, the ketogenic diet is becoming more popular with every passing year. In order to make inducing a state of ketosis easier, some have taken to supplementing with ketone bodies.

This practice is reasonably new and has been shown to induce a type of ketosis within minutes of ingesting a supplement. There is virtually no knowledge on the long-term effects of taking ketone supplements and preliminary evidence suggests that the metabolic effects of such supplements are different to that of consuming a ketogenic diet.^[16] Ingesting ketone bodies increases ketone levels but suppresses ketogenesis (the cellular generation of ketones from fat burning).^[17]

In this regard, ketone supplements are not likely to promote weight loss and may not induce negative side effects associated with starting a keto diet (“keto flu”).

Limited evidence suggests that ketone supplements may help to improve symptoms associated with psychiatric conditions^[18] and diabetes.^[19] However evidence pertaining to enhancing physical performance is currently controversial.^{[20] [21]} More research is required before conclusions can be drawn on using ketone bodies in order to benefit from transient states of ketosis.

15. Atkins Diet

The Atkin’s Diet is a high fat (60-68%), high protein, and low carbohydrate diet. Carbohydrates are restricted to less than 30g per day,^[22] which is a very extreme restriction from a dietary standpoint.

It was one of the first health fad diets that challenged a more conventional dietary approach in order to get quick weight loss results.^[23] Studies reveal that it does induce rapid weight loss in a similar fashion to a ketogenic diet; however the weight may be regained the moment a normal diet is resumed. This is also not likely to be a very safe diet to adopt on a long-term basis.

This diet has been severely critiqued for being incredibly unbalanced and more of an extreme diet than many other commercial ketogenic diets. The above average protein content of the diet combined with the very high level of fats is prone to promoting kidney disease, amongst other health concerns.^[24]

One aspect of this diet that differentiates it from a normal keto diet is the high protein content. A high level of protein is known to inhibit ketosis and worsen the health problems associated with consuming an unbalanced high fat diet.

Advantages

There is only one real advantage to following the Atkin’s Diet:

• Promotes rapid weight loss with a greater reductions in weight when compared to other very low carb diets.^[25]

Disadvantages

The disadvantages of the Atkin’s Diet are as follows:

• Weight is regained once diet is no longer followed.
• Following the diet may result in micronutrient deficiencies.^[26]
• May increase the risk of ketoacidosis and heart disease.^[27]
• Weight loss in comparative studies reveal inconsistent results, with some studies showing it is not nearly as effective as other low carb diets.^[28]

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