Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat. Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag.

2. Hyperprotein Diets Dr. Clarence P. Davis Bergstrasse 8 CH-8702 Zollikon

3. Dr. C.P. Davis Subjects General remarks on Obesity an associated riscs Role of Protein in the Diet Definition of high Protein Diets High Protein Diets and Weight Reduction Atkins, Zone, Protein Power, Sugar Busters, Stillman

4. Dr. C.P. Davis 1991 Obesity Trends* Among U.S. AdultsBRFSS,1991, 1996, 2004 (BMI 30) 1996 2004 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Source: Centers for Disease Control and Prevention

5. Dr. C.P. Davis Obesity in Europe Source: IOTF women men Yugoslavia Greece Romania Czech Rep. England Finland Germany Scotland Slovakia Portugal Spain Denmark Belgium Sweden France Italy Netherlands % BMI  30 Norway Hungary Switzerland 30 40 30 0 40 20 10 10 20

7. uterus

8. gallbladder

9. kidney

10. colonhormonal imbalances hyperuricemia and gout

11. Dr. C.P. Davis Risks associated with Obesity NIH/NHLBI The Practical Guide, Identification, Evaluation and Treatment of Overweight and Obesity in Adults, October 2000.

12. Dr. C.P. Davis Obesity and heart failure: cumulative incidence in women BMI >30kg/m2 BMI 25.0-29.9kg/m2 BMI 18.5-24.9kg/m2 Kenchaiah S et al N Engl J Med. 2002 Aug 1;347(5):305-13

13. Dr. C.P. Davis Obesity and heart failure: cumulative incidence in men BMI >30 kg/m2 BMI 25.0-29.9kg/m2 BMI 18.5-24.9kg/m2 Kenchaiah S et al N Engl J Med. 2002 Aug 1;347(5):305-13

14. Dr. C.P. Davis BMI and age related mortality 2.4 2.4 women men age 50-54 55-59 60-64 2.2 2.2 2.0 2.0 1.8 1.8 Relative risk 1.6 1.6 1.4 1.4 1.2 1.2 1.0 1.0 0.8 0.8 21 25 29 33 37 41 21 25 29 33 37 41 BMI (kg/m2) BMI (kg/m2) after Waaler HT Acta Med Scand Suppl. 1984;679:1-56

15. Dr. C.P. Davis The diet generation ~ 30% of all male and ~ 45% of all female US citizens are trying to lose weight Diet books available on Amazon.com: ~ 38’000 Many of these books promote some sort of CHO restriction and hyperprotein diet Dr. Atkins’ New Diet Revolution, The Carbohydrate Addict’s Diet, Protein Power, Lauri’s Low-Carb Cookbook

16. Dr. C.P. Davis Important Questions What is really known about CHO restriction? Is the information scientifically sound? What is the effect on composition of weight loss (fat vs. LBM) micronutrient status (vitamins and minerals) metabolic parameters (blood glucose, insulin sensitivity, blood pressure, lipid levels, uric acid, ketone bodies)?

17. Dr. C.P. Davis Role of Protein in the Diet Proteins are essential components of the body and are required for the body’s structure and proper function Enzymes, hormones, antibodies, transport and structural components The nutritional quality of food proteins varies and depends on essential amino acid composition (egg white = biological value of 100) Foods with high protein quality are from animal source eggs, milk, meat, poultry, fish

18. Dr. C.P. Davis Role of Protein in the Diet In the US an average of 102 g of protein per person per day is available in the food supply Actual protein consumption ranges from 88 to 92 g for men and 63 to 66 g for women (12-15 % of total daily energy uptake) Animal products provide ~ 75% of the essential amino acids in the food supply, followed by dairy products, cereal products, eggs, legumes, fruits, and vegetables The RDA for protein of high biological value for adults is ~ 0.8 g/kg BW (~ 8-10% of total daily energy uptake)

19. Dr. C.P. Davis Definition of high protein diets High protein diets: >20% of total energy Very high protein diets: >30% of total energy

20. Dr. C.P. Davis Protein Intake at Various Levels of Energy Intake St. Jeor ST, Ashley JM. In: Obesity: Impact on Cardiovascular Disease. 1999:233-246.

21. Dr. C.P. Davis Compensatory Changes in the Macronutrient Composition of Various Diets

22. Dr. C.P. Davis Some popular Diets Atkins Eating too many CHO causes obesity and other health problems; ketosis leads to decreased hunger Meat, fish, poultry, eggs, cheese, low-CHO vegetables, butter, oil; no alcohol Protein: 27%, CHO: 5%, Fat: 68% (saturated 26%) No long term validated studies published Initial weight loss mostly water. Difficult to maintain long-term because diet restricts food choices

23. Dr. C.P. Davis Some popular Diets Zone (Montignac) Eating the right combination of foods leads to metabolic state at which body functions at peak performance, leading to decreased hunger, weight loss, and increased energy Protein, fat, CHO must be eaten in exact proportions (40/30/30). Low-glycemic-index foods, alcohol in moderation Protein: 34%, CHO: 36%, Fat: 29% (saturated 9%), Alcohol: 1% No long term validated studies published. Theories highly questionable. Weight loss based on caloric restriction. Could result in weight maintenance if carefully followed. Diet rigid and difficult to maintain.

24. Dr. C.P. Davis Some popular Diets Protein Power Eating CHO releases insulin in large quantities, which contributes to obesity and other health problems Meat, fish, poultry, eggs, cheese, low-CHO vegetables, butter, oil, salad dressings, alcohol in moderation Protein: 26%, CHO: 16%, Fat: 54% (saturated 18%), Alcohol: 4% No long term validated studies published Weight loss based on caloric restriction. Limited food choices not practical for long term.

25. Dr. C.P. Davis Some popular Diets Stillman High-protein foods burn body fat. If CHO are consumed, the body stores fat instead of burning it Lean meats, skinless poultry, lean fish and seafood, eggs, cottage cheese, skim-milk products; no alcohol Protein: 64%, CHO: 3%, Fat: 33% (saturated 13%) No long term validated studies published Initial weight loss mostly water. Maintenance based on strict caloric counting. Very limited food choices not practical for long term.

26. Dr. C.P. Davis Comparison of various diets with regard to Body Fat, Body Protein and Body Water The best results were achieved with a combination of 50 g of proteins, 25 g CHO, and 10 g of fat Wechsler JG et al. Fortschr Med. 1984 Jun 28;102(24):666-8

27. Dr. C.P. Davis Effects of HPD Skov et al. Int J Obes Relat Metab Disord. 1999; 23:528-536 65 healthy overweight men and women 2 ad lib fat reduced (< 30% kcal) diets varying in protein content (12% vs 25% of kcal) over 6 months Larger weight loss with higher-protein diet (8.9 kg) vs lower-protein diet (5.1 kg) Larger fat loss with higher-protein diet (7.6 kg) vs lower-protein diet (4.3 kg)

28. Dr. C.P. Davis Effects of HPD On average, consumption of HPD and/or low-CHO diets resulted in 12-wk and 24-wk weight losses that were 2.5 ± 1.8 and 4.0 ± 0.4 kg greater, respectively, than those from consumption of the high CHO and/or low-fat control diets. This implies a 233 kcal/day difference in energy balance

29. Dr. C.P. Davis Effects of HPD Two possible hypotheses for difference in energy balance 1) a low-CHO diet may increase energy expenditure 2) an increase in protein in the diet may increase energy expenditure

30. Dr. C.P. Davis Do Proteins increase Energy Expenditure? Mikkelsen et al. Am J Clin Nutr. 2000; 72:1135:1141 Ad lib diet Increase of protein from 11% to 28/29% No change in fat (29%) Reduction of CHO from 60% to 42/43% Increase in energy expenditure by about 60 – 120 kcal/24 hour, depending on whether the protein was of plant or animal origin

31. Dr. C.P. Davis Do Proteins increase Energy Expenditure? Whitehead JM et al. Int J Obes Relat Metab Disord. 1996; 20:727-732 50% energy restricted diet Increase of protein from 15 – 36% Compared with the weight-maintenance control diet both diets resulted in a reduction of 24-hour energy expenditure Smaller reduction for higher-PD by 71 kcal/d compared with the lower-PD Lesser decrease of resting metabolic rate Lesser decrease of thermic effect of food

32. Dr. C.P. Davis Do Proteins increase Energy Expenditure? Not sure Small results cannot explain the effect of the average 2.5 kg greater weight loss reported from low-CHO diets

33. Dr. C.P. Davis Reasons for higher Weight loss with HPD Dietary compliance Difficult to document Some evidence from comparative studies with low-fat diets vs. low-CHO/HPD and theoretical weight loss Possible higher satiating effect of proteins

34. Dr. C.P. Davis Mean Self-reported Dietary Adherence Scores of All 4 Diet Groups, According to Study Month CHO-restriction Glucose-restriction Fat-restriction Calorie-restriction Comparison of different diets with respect to compliance Dansinger ML et al. JAMA. 2005 Jan 5;293(1):43-53

35. Dr. C.P. Davis One-Year Changes in Body Weight as a Function of Diet Group and Dietary Adherence Level for All Study Participants Comparison of different diets with respect to weight loss Dansinger ML et al. JAMA. 2005 Jan 5;293(1):43-53

36. Dr. C.P. Davis Reasons for higher Weight loss with HPD Limitation of food choices associated with low-CHO diets Low-CHO diets induce small losses of body water (~ 1.5-2 kg) Does not explain the difference generally reported for comparisons of low-CHO and low-fat diets 1.9 kg is lesser than reported Greater weight loss is reported to be based on fat loss not water

37. Dr. C.P. Davis Limitations of current studies and outlook Very few “pure” studies on HPD Impossibility of manipulating one macronutrient without changes in at least one other macronutrient Studies on energy expenditure may not give the right picture Too short time frame Weight losses found in 12 weeks may not be representative of long-term effect

38. Dr. C.P. Davis Comparison of Weight Loss Foster GD et al. N Enlg J Med 2003 22;348(21):2082-90

39. Dr. C.P. Davis Urinary Ketosis Foster GD et al. N Enlg J Med 2003 22;348(21):2082-90

40. Dr. C.P. Davis Limitations of current studies and outlook Usually studies investigate only one side of the energy balance equation Health issues are rarely investigated The amount of protein recommended in HPD exceeds established requirement and may impose significant health risks Little cross-sectional and longitudinal studies provide data on health effects of HPD

41. Dr. C.P. Davis Risks associated with HPD Animal protein, saturated fat, and cholesterol raises LDL-cholesterol HPD increase purine levels gout HPD increase urinary calcium loss osteoporosis Deficiencies in essential vitamins, minerals, and fibers Increased cancer risk low phytochemical) VHPD with excessive limitations of CHO may lead to loss of lean muscle tissue (glyconeogenesis) Larosa JC et al. J Am Diet Assoc 1980; 77:264-270 Franzese TA. In: Kause‘s Food, Nutrition, & Diet Therapy. 2000:970-986 Barzel US et al. J Nutr 1998; 128:1051-1053 Costill DL et al. Sports Med 1992; 13:86-92

42. Dr. C.P. Davis High-protein Diets and Weight Reduction Weight reduction is achieved if there is an energy deficit (energy uptake < energy expenditure) In obese individuals, macronutrient composition has little effect on the rate or magnitude of weight loss unless nutrient composition influences caloric intake Overall caloric intake depends on palatability and satiety Proteins are easily available, palatable and of high essentiality

43. Dr. C.P. Davis High-protein Diets and Weight Reduction High-protein diets are initially attractive quick weight loss due to low CHO intake, glycogen depletion, and ketosis High-protein diets usually induce metabolic ketosis Ketosis may lead to lower caloric intake VHPD may promote negative energy balance due to significant food restrictions

44. Dr. C.P. Davis High-protein Diets and Weight Reduction The structured eating plan, strict eating schedules, and limited tolerance for high-protein foods reduce overall flexibility but offer initial appeal. These characteristics may help limit caloric intake and may account for weight loss. However, neither the efficacy of these diets compared with higher COH diets in promoting weight loss nor the safety of these diets has been documented in long-term studies. St. Jeor ST et al. Circulation 2001; 104; 1869-1874

45. Dr. C.P. Davis General Recommendation for HPD The current evidence, combined with the need to meet all nutrient requirements, suggests that weight-loss diets should be moderate in CHO, moderate in fat, and that protein should possibly contribute one fourth to one third of energy intake.