IS OPTIMAL PROTEIN INTAKE ENOUGH TO OPTIMIZE MUSCLE MASS IN AILING PATIENTS? To answer this question I would like to go back to the Wolfe paper I first discussed. In this paper the following is stated: “The information presented above leads to the conclusion that the catabolic response accelerates net protein breakdown to an extent that cannot be entirely reversed by nutritional support alone. Consequently, we have investigated a wide range of anabolic agents in the setting of severe injury. To be effective, a potentially anabolic agent must work in conjunction with optimal amino acid and protein nutrition…”
Wolfe then goes on to discuss only pharmaceutical anabolic agents. Do non-pharmaceutical anabolic agents exist that we can readily employ as nutritional practitioners? I will discuss two – one of which you are probably aware and another of which you may not be aware.
The first is exercise, which I would guess needs no elaboration here to convince you of efficacy. However, the other, because it is less well known in the nutritional community, probably deserves some elaboration.
Beta-hydroxy-beta-methylbutyrate (HMB) – an effective anabolic agent
Beta-hydroxy-beta-methylbutyrate (HMB) is discussed in the paper “Beta-hydroxy-beta-methylbutyrate supp- lementation and skeletal muscle in healthy and muscle- wasting conditions” by Holecek (Holecek M. J Cachexia, Sarcopenia and Muscle, Vol. 8, pp. 529-541, 2017). What is HMB? “Beta-hydroxy-beta-methylbutyrate (HMB) is a metabolite of the essential amino acid leucine that has been reported to have anabolic effects on protein metabolism.”
Is it
individuals who are losing muscle mass? As you will see from the following quote, it is as long as it is combined with exercise: “Studies have demonstrated that HMB can prevent the development of sarcopenia in elderly subjects and that the optimal action of HMB on muscle growth and strength occurs when it is combined with exercise.”
Of course, I realize that the reality of treating chronically ill patients is that motivating them to exercise is often difficult. Therefore, please keep in mind that what I have suggested concerning the use of HMB and optimum protein amino acid intake in your chronically ill patients is not an “all or none” phenomenon. While exercise will optimize their impact, hopefully I have convinced you that, even without exercise, clinical outcomes will improve, even in your very difficult to manage chronically ill cases, when optimal protein intake though diet and supplementation is employed. Furthermore, the results seen with dietary and supplemental protein can be enhanced with the use of HMB.
SOME FINAL THOUGHTS ON THE SUBJECT Throughout most of the history of the clinical nutrition movement default thinking when considering supplemen-
THE ORIGINAL INTERNIST MARCH 2018 effective as optimizing muscle mass in ailing
tation
vitamins and minerals.
healthy individual who wants to stay healthy and is, therefore, requesting a supplemental “insurance policy” as it so often has been described, vitamins and minerals are generally what first comes to mind for both patients and practitioners. Has this “vitamins and minerals first” policy towards supplements served patients and the public well over the years? In terms of quality of life concerns, I would guess that the general consensus would be yes, as suggested by sales of vitamin and mineral supplements nationwide. However, there is another disturbing trend that I feel is growing at an exponential rate that provides a powerful argument against a “vitamins and minerals first” approach to supplemental recommendations for everyone. To me, it suggests a need to not eliminate the “vitamins and minerals first” approach but to expand it to include, as the data above points out, another supplement all too rarely considered.
As the statistics
more people who regularly ingest vitamin and mineral supplements are or will be experiencing chronic health complaints.
supplementation is worthless, as inferred by many critics? For me, the answer is no. As more than a violin is needed to play Beethoven’s 5th symphony, there is no question, based on a large body of research, that more is needed for many of today’s chronically ill patients than vitamins and minerals. What might be the most foundational, most under-appreciated supplement that
complement vitamins and minerals for this population? I hope I have convinced you, based on the research presented above, that supplement is protein/amino acids.
As I mentioned in the beginning of this monograph, my goal to begin this new year is to convince you that, for many people you encounter, your first thought concerning supplementation should not be vitamins and minerals but vitamins, minerals, and protein/amino acids. I look forward to your thoughts as to whether I have succeeded.u
is needed to Does this mean vitamin and mineral reported above suggest, more and
for an ailing individual has been in terms of Similarly, for the reasonably
CDID Symposium May 4-6, 2018 Las Vegas, NV See page 8
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