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"Diabetes Spectrum
Volume 13 Number 3, 2000, Page 132
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From Research to Practice/ Medical Nutrition Therapy
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Protein Controversies in Diabetes"
http://journal.diabetes.org/diabetesspe ... /pg132.htm
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"Does eating a high-protein diet cause renal disease?
Despite the widespread belief that protein ingestion can influence the development of renal disease, dietary intake of protein is reported to be similar in patients with or without nephropathy. Nyberg et al.36 investigated protein intake in three groups: 1) patients who had diabetes 30 years or more without nephropathy; 2) patients with nephropathy but stable glomerular filtration rates; and 3) patients with progressive nephropathy and declining glomerular filtration rates. In all three groups, average protein intake was >80 g/day (~16–17% of daily calories), with no relationship between the amount of protein ingested and the progression of nephropathy.
Watts et al.37 investigated dietary protein in patients with type 1 diabetes with and without microalbuminuria. Dietary protein intake was similar in both groups. Ekberg et al.38 also found no support for a relationship between high protein intake and glomerular hyperfiltration in insulin-treated patients. In tobacco users with hyperfiltration, a positive relationship was found between urinary albumin excretion and protein intake, but this was not found in non-users of tobacco. Jameel et al.39 reported on dietary protein intake and clinical proteinuria in patients with type 2 diabetes. Again, protein intake was simila, with no correlation between protein intake and clinical proteinuria. In all of the above studies, protein intake was in the range of usual dietary intake and rarely exceeded 20% of the calories.
In a cross-sectional, clinic-based study (EURODIAB IDDM Complications Study) of more than 2,500 people with type 1 diabetes, individuals who reported protein consumption of <20% of total calories had average albumin excretion rates (AERs) below 20 mg/min. However, in those in whom protein intake was >20% (22% of patients), average AERs increased and were in the microalbuminuric range (>20 mg/min). Of the patients with macroalbuminuria, 32% consumed >20% of protein, while this percentage was 23% for the microalbuminuric and 20% for the normoalbuminuric individuals with type 1 diabetes. Trends reached statistical significance for total protein and animal protein, while no association was seen for vegetable protein. This trend was particularly pronounced in patients with hypertension and/or elevated HbA1c values. These findings support the recommendation for people with diabetes not to consume protein intakes >20% of total calories.40
In an interesting study, excess microalbuminuria was related to saturated fat intake and not to protein. In a cross-sectional, population-based study of Tasmanian adults with type 1 diabetes with microalbuminuria, on at least two or three occasions, excess microalbuminuria was associated with relative high intakes of saturated fat and a decreased prevalence with relative high intakes of protein.41
High-Protein, Low-Carbohydrate Diets
Weight loss and improved blood glucose control are claims being made for high-protein, low-carbohydrate diets. The advantages of the high-protein, low-carbohydrate approach are that diets that eliminate a whole category of nutrients, in this case carbohydrates, are lower in calories and so result in weight loss. With a high protein intake and strict limitation of carbohydrate, water stored with glycogen (carbohydrate) is released. This rapid loss of fluid is an initial boon to dieters looking for fast results. Unfortunately, it isn't stored fat that is being lost. Fasting ketosis, which results in loss of appetite, may also develop. Furthermore, few people can eat endless amounts of animal protein and fat for weeks on end, and so they eat less and less. The good news is that, with a high-protein diet, weight is lost, insulin needs drop, and blood glucose and sometimes even lipid levels often improve. It works, at least temporarily.
Although the authors of the popular books all take a slightly different approach, the basic premises are fairly similar. Eating a high-carbohydrate diet makes people "fat" because carbohydrates increase blood glucose levels, causing a greater release of insulin, and higher insulin levels cause carbohydrate to be stored easily as fat. Eating a high-protein diet leads to weight loss, decreased insulin levels, and improved glycemia. However, neither this nor the claim to "cure" insulin resistance—the oversecretion of insulin which they say causes carbohydrate to be stored as fat—with a low-carbohydrate, high-protein diet is supported by scientific evidence.
Nor is there good evidence that insulin resistance from eating a diet rich in starchy foods and sugar is the cause of obesity. In fact, it is obesity that causes insulin resistance, not the other way around. But regardless, increased physical activity, energy restriction and/or moderate weight loss, and controlling fat intake have been shown to improve insulin sensitivity, not changes in the protein-to-carbohydrate ratio.42,43
High-protein diets claim to offer other benefits. For example, protein stimulates the release of glucagon, a hormone that raises the level of blood glucose and counteracts the actions of insulin, and eating right means balancing insulin and glucagon levels. Therefore, the argument goes, if not enough protein is eaten, too much insulin is released and not enough glucagon. It is true that the balance of insulin and glucagon release is important in the metabolism and storage of nutrients. But it is doubtful that you can change the balance by eating more protein.
Another claim is that if the right kinds of fat are eaten, individuals will not become fat. However, there appears to be a hierarchy for the autoregulation of substrate utilization and storage that is determined by storage capacity and specific fuel needs of certain tissues.44 For example, alcohol has the highest priority for oxidation because there is no body storage pool for it, and conversion of alcohol to fat is energetically expensive. Amino acids and carbohydrates are next in the oxidative hierarchy. Body proteins are functional, and there are not storage depots for amino acids. There is a limited capacity to store carbohydrate as glycogen, and conversion of carbohydrate to fat is energetically expensive as well. In contrast, there is virtually unlimited storage capacity for fat, largely in adipose tissue, and the storage efficiency of fat is high. Because of the oxidative priority of alcohol and protein, the body has an exceptional ability to maintain their balance across a wide range of intake of each. Carbohydrate oxidation closely matches carbohydrate intake.45,46 Therefore, the amount of fat oxidized or stored is the difference between total energy needs and the oxidation of the other priority fuels—alcohol, protein, and carbohydrate."
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