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ICMR NUTRITION GUIDELINES 2024 BREAKDOWN : LSFITNESS

Statement 1 : Some protein powders, marketed in packages as protein supplements, contain protein from multiple sources. Protein powders may also contain added sugars, non-caloric sweeteners and additives such as artificial flavoring, hence, are not advisable to be consumed on a regular basis.

My Take: Protein powders that contain proteins from multiple sources are known as protein blends. These blends often include whey protein, casein protein, albumin, and others. Protein blends are completely safe for use if they are manufactured and processed in facilities that adhere to strict safety standards, such as those following HACCP (Hazard Analysis and Critical Control Points) guidelines.

Statement 2 : Protein powders may also contain added sugars, non-caloric sweeteners and additives such as artificial flavoring, hence, are not advisable to be consumed on a regular basis.

My Take: Protein powders may contain added sugars, non-caloric sweeteners, and artificial flavorings. However, these additives are commonplace in many foods we consume today. Rather than casting a negative light on whey protein supplements, it would be more beneficial to implement strict regulations that limit the use of added sugars. Additionally, encouraging the use of healthier non-caloric sweeteners, such as Fructo-oligosaccharides (FOS), and replacing artificial flavorings with natural ones could improve the nutritional quality of these supplements.

Statement 3 : Whey protein is rich in branched chain amino acids (BCAAs). Recent evidence suggests that BCAAs may increase the risk of certain non-communicable diseases (NCDs). As mentioned above, adequate non-protein energy from carbohydrate and fat is essential for dietary proteins/AA to be utilized for protein synthesis and for related functions in the body. Consuming high level of protein, especially in the form of protein supplement powders, is therefore not advisable.

My Take: Whey protein is indeed rich in branched-chain amino acids (BCAAs): leucine, isoleucine, and valine. Recent evidence has shown a direct correlation between elevated plasma levels of BCAAs and insulin resistance, but this does not necessarily mean it is caused solely by high consumption of BCAAs. The condition may also be due to dysfunctional BCAA catabolism, existing insulin resistance, or being overweight or obese.

Elevated plasma BCAA levels have been observed in individuals who are overweight or obese and exhibit insulin resistance, and these levels are higher compared to healthy individuals. Observational studies have found that plasma BCAA levels are also elevated in patients with Type 2 diabetes when compared to age and BMI-matched controls without diabetes.

Insulin plays a critical role in the metabolism of BCAAs. Results from Mendelian randomization studies indicate that insulin resistance drives higher plasma BCAA levels, and large-scale genetic studies suggest a causal role of diminished BCAA catabolism in underlying insulin resistance.

Dysfunctional BCAA catabolism may lead to the accumulation of a number of BCAA catabolic metabolites in the plasma of insulin-resistant individuals with obesity or Type 2 diabetes, including BCAA-derived acylcarnitines, 3-HIB, 2-HB, and 2-KB. These can have toxic effects on cellular functions. It has been shown that acylcarnitines can cause mitochondrial dysfunction in several tissues and anaplerotic stress, thus dysregulating glucose and fat oxidation.

While there is evidence that elevated BCAA levels can impair insulin signaling pathways, it remains unclear whether elevated BCAA levels are a cause or a consequence of insulin resistance. Most studies measure plasma BCAA levels rather than in peripheral tissues, so future research focusing on peripheral tissues could provide a better perspective on tissue-specific BCAA catabolism.

Statement 4 : Most athletes can get the recommended amount of protein through food alone, without the use of supplements. Protein powders are not required. Moreover, prolonged intake of a large amount of protein is associated with potential dangers, such as bone mineral loss and kidney damage.

My Take: Athletes can obtain the recommended amount of protein through their diet alone, depending on what they eat.

For example, a non-vegetarian athlete can easily meet protein needs from sources such as chicken breast, mutton, and whole eggs while maintaining overall caloric intake, as these sources contain fewer ancillary calories.

Conversely, let's consider an athlete who follows a vegan diet. Major vegan protein sources like tofu, cereals and millets, and pulses and legumes do provide some protein. However, if an athlete relies solely on these foods without supplements, the total calorie count may exceed caloric requirements due to the additional carbohydrates and fats in these protein sources.

Regarding the safety of protein consumption, prolonged intake of a significant amount of protein—ranging from 25-75 grams daily—has not been associated with potential dangers such as bone mineral loss and kidney damage. In fact, studies have shown a positive impact on bone mineral density.

The European Society on Parenteral and Enteral Nutrition (ESPEN) advocates for a higher protein intake of 1.0–1.5 g/kg/day to help slow age-related muscle loss.

There is no evidence to suggest that a high protein diet can cause kidney damage in individuals with healthy renal function. However, those with kidney disease, such as chronic kidney disease (CKD), should limit their protein intake.

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Serum Vitamin B12 vs. Urine Methyl Malonic Acid: Which is the Superior Marker for B12 Status?

Introduction:

Vitamin B12 plays a pivotal role in numerous physiological processes. Determining its deficiency with accuracy is essential for effective healthcare. While serum vitamin B12 is a standard test, urine methyl malonic acid (MMA) may offer a clearer window into the body's B12 status.

1. Biochemical vs. Functional Indicators

Serum Vitamin B12: Reflects the vitamin's concentration in the blood but may not truly indicate its functionality at a cellular level.

Urine MMA: Elevated levels suggest a functional B12 deficiency, showcasing metabolic changes due to insufficient B12.

2. Sensitivity and Early Detection

Serum B12 might not detect early or mild deficiencies. In such borderline scenarios, urine MMA's elevated levels can indicate even the slightest B12 shortages.

3. Specificity of the Test

Urine MMA is closely linked to B12 status, making it a more specific marker. In contrast, serum B12 can be influenced by factors like inflammation or liver conditions.

4. Pernicious Anemia and Its Challenges

In this autoimmune condition, serum B12 levels can be misleading. MMA, however, provides a more direct insight into the body's B12 status.

5. Detecting Subclinical Deficiencies

Even with "normal" serum B12 levels, some might suffer at a cellular level. Urine MMA is adept at identifying such subclinical deficiencies.

Conclusion:

While serum B12 is still widely used, urine MMA brings several advantages to the table, especially in nuanced or complex cases. As always, it's essential to consider the whole clinical picture, including symptoms and patient history, when gauging vitamin B12 status.