meals

Protein and Carbs

David Mendosa Health Guide September 24, 2008
  • More protein in our diet is good for us, says one of the country's top diabetes researchers, Osama Hamdy, MD and PhD. He is the medical director of the obesity clinical program at Joslin Diabetes Center in Boston.

    But whether you are a vegetarian or not protein still presents problems.

    He spoke about "Higher Levels of Protein Intake are Good" at the American Diabetes Association's June annual meeting in San Francisco, as I previously reported here. Since then, he has posted his slides for that presentation online.

    We got to know each other in San Francisco and have been in touch by email.  And we just got another chance to talk about his protein concerns.


    On one hand, vegetable protein is better for us than animal protein, Dr. Hamdy told me when I called him yesterday. Amino acids are the key.

    The building blocks of protein are amino acids. Our cells use 20 standard amino acids.

    Scientists call some of these amino acids the essential ones. They aren't essential because they are more important than the others. They are essential because our bodies don't synthesize them, so we have to include them in our diet.

    All of us require eight of them: phenylalanine, valine, threonine, tryptophan, isoleucine, methionine, leucine, and lysine.  In addition, four more are essential in the diet of infants and growing children.

    But most animal protein has a lot of two of these amino acids, lycine and valine, Dr. Hamdy says. Too much of these amino acids are hard on our kidneys. They can cause cause too much pressure inside the kidneys and the blood vessels in the kidneys to expand.

    So maybe all should become vegetarians? I asked Dr. Hamdy that.

    Actually, vegetarians have protein problems of their own, he says. But different problems than those facing meat-eaters.

    The problem with vegetable protein is the opposite of that meat-eaters have. Rather than too much of two amino acids, vegetable protein has too little of several of them.

    Which amino acids? When I pressed Dr. Hamdy to specify them, he demurred. He didn't want to get technical. "Several of them," he replied.

    Then, what should vegetarians do? If they are committed to remaining completely vegetarian for religious, ethical, or other reasons, they need to take "ketoanalog amino acid supplements."

    Better, he implied would be to supplement their diet with that animal protein that doesn't cause kidney problems. This is the protein that we get from dairy, egg whites, or fish.

    For me this was good news. I get most of my protein from my usual breakfast of two poached egg whites and my lunch or dinner of strained yogurt and fish, particularly salmon and sardines, which are among the best sources of omega 3 fatty acids.

    But Dr. Hamdy's advice also encourages me to get more of the protein I need from vegetarian sources. Many soy-based foods are among the best sources of protein. Spinach surprised me by being one of the foods with the most grams of protein per 100 calories. If you have no gluten intolerance, seitan is a protein-rich and tasty food.


  • Since Dr. Hamdy is a leading advocate of a higher protein diet, I had to ask him about the Why WAIT program of which he is the principle investigator. This Weight Achievement and Intensive Treatment Program is the world’s first clinical practice program designed to help patients with diabetes lose weight through a novel multidisciplinary approach.


    He is the lead author of "The Why WAIT Program: Improving Clinical Outcomes Through Weight Management in Type 2 Diabetes," which  Current Diabetes Reports will publish in its October 2008 issue. The abstract is online.

    He is also the lead author of "Why WAIT Program: A Novel Model for Diabetes Weight Management in Routine Clinical Practice," which the journal Obesity Management just published in its August 2008 issue. The citation is online. The study shows that people with type 2 diabetes enrolled in the program lost on average 23.5 pounds -- or 9.8 percent of their initial body weight -- during the 12-week program. 

    Why, I asked, did participants in that program get 40 percent of their daily caloric intake from carbohydrates? They developed those meal plans according to the Joslin Nutrition Guidelines for obese patients with diabetes, he told me.

    At the same time he indicated his preference for a lower carbohydrate diet. "The American medical establishment is awfully conservative."