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Inappropriate use of Protein shakes could lead to protein toxicity

Inappropriate use of Protein shakes could lead to protein toxicity

Editor: Dr. Praful B. Godkar (Ph.D)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.

High-protein consumption above the recommended dietary allowance for adults (RDA: 0.8 g protein/kg body weight/day) is on the increase in the general population(1, 2). The main reason is the protein shake market in India is growing; due to health and wellness awareness, the demand for fitness, sports nutrition and the increase in vegan and vegetarian populations. However, in a prospective cohort study it was investigated that high protein intake may cause protein toxicity and influences the rate of renal function change over a long period. The results showed that high total protein intake, particularly high intake of non-dairy animal protein, may accelerate renal function decline with significant renal insufficiency(3) (Refer Case study). Latest-devised IVD Body profile tests(6,7) advised by the family physicians; could be useful to diagnose early stage of kidney disease and timely treatment due to long-term intake of protein shakes.

Q1. What is protein toxicity and related symptoms?

ANS: Protein toxicity is the effects of the accumulation of end products of protein metabolism such as urea, creatinine, uric acid, and ammonia. Symptoms of protein toxicity include tiredness, loss of appetite, unexplained vomiting, depression, nocturnal polyurea and edema on feet and face. Prolonged protein toxicity may lead to serious complications such as seizures, encephalopathy, and severe kidney damage (Refer Case study).

CASE STUDY

A 27 year-old-man, presented with edema on face and feet, nausea, vomiting, fatigue, and shortness of breath. His blood pressure was 165-95. From his case study it was found out that he was on high protein supplements containing branch chain amino acids for the past two years. His laboratory test values were as follows :

PARAMETER VALUE REFERENCE RANGE (NORMAL RANGE)
1) Serum urea nitrogen 105 mg/dl 7.0 – 21 mg/dl
2) Serum creatinine 7.6 mg/dl 0.7 – 1.5 mg/dl
3) Urine proteins Present +++ Absent

Q2. What is the probable diagnosis?

ANS: Very high values of blood urea nitrogen and serum creatinine, indicate that patient was suffering from severe renal disease.

Q3. What is the biochemical basis for renal disease?

ANS: Long-term inappropriate high dietary protein intake can cause intraglomerular hypertension, which may result in kidney hyperfiltration, glomerular injury, and proteinuria. Long-term high protein intake may lead to chronic kidney disease.
Note:
Branched-chain amino acids (BCAA) are used by athletes to improve athletic performance, prevent fatigue, improve concentration, and reduce muscle breakdown during intense exercise. But there is limited scientific research to support the benefits of BCAA. High protein supplements with BCAA should be used cautiously under appropriated medical supervision.

Q4. What is the first line of treatment?

ANS: It is necessary to stop high intake of protein supplements immediately and then to consult a Nephrologist as soon as possible.

Q5. What are the observations of latest ‘National Poll surveys’ on the increased use of protein shakes by teens in the general population?

ANS:

POLL SAMPLES POLL RESULTS
Two in five parents, and more parents of teen boys than parents of teen girls 41% teens consumed protein supplements every day (Boys: 46%, Girls 31%)
Note :
  1. The forms of protein consumed were:
    1. Shakes (28%)
    2. Powder (15%)
    3. Bars (31%)
    4. Diet (7%).
  2. Reasons for high protein consumption: To-
    1. Build muscles (56% boys, 18% girls)
    2. Improve sports performance (54% boys, 36% girls)
    3. Replace meal (18% boys, 34% girls),
    4. Gain weight ( 6% boys, 11% girls).
  3. Encouraging factors that influenced the teens to use protein supplements:
    1. Parents (44%)
    2. Trainers or coaches (22%)
    3. Friends (21%)
    4. Social media (10%)
    5. Healthcare providers (9%).

Q6. What specific ‘Kidney function tests’ are prescribed?

ANS: 

ROUTINE KIDNEY FUNCTION TESTS(6, 7) CLINICAL SIGNIFICANCE
(1) Blood Urea Nitrogen (BUN) High values with high serum creatinine indicate kidney dysfunction
2) Serum creatinine High values indicate kidney dysfunction
3) Serum Total Proteins, Albumin, Globulins Low values and presence of protein in urine indicate kidney dysfunction
4) Creatinine clearance Low values indicate kidney dysfunction
5) Glomerular Filtration Rate (GFR or eGFR) Low values indicate kidney dysfunction
Note:
1) High or low values means compared to the respective “Normal ranges” (Reference ranges).

Q7. Any specific recent IVD POCT that could impact the monitoring of kidney functions?

ANS: Blood Proenkephalin A 119–159 (PENK) has been intensively studied as a novel biomarker of kidney function. The normal range for proenkephalin (PENK) is 9–518 pmol/L. The POCT method is based on Sandwich ELISA.
Note :
(1) Increased plasma PENK concentrations are found to be associated with long-term kidney outcomes and mortality.
(2) PENK belongs to the enkephalin peptide family and is freely filtrated in the glomerulus (and not absorbed). Plasma PENK concentration correlates very well with GFR. Moreover, increased plasma PENK concentrations are found to be associated with acute kidney injury and mortality(8).

References

(1) C.S. Mott Children’s Hospital, Susan B. Meister Child Health, National Poll on Children’s Health, Evaluation and Research Center, 300 North Ingalls Building Ann Arbor, MI 48109-5456.

(2) International Market Analysis Research and Consulting Group(IMARC) report 2024.

(3) Ioannis Delimaris. Adverse Effects Associated with Protein Intake above the Recommended Dietary Allowance for Adults.ISRN Nutr. 2013 Jul 8;2013:126929. doi: 10.5402/2013/126929.

(4) Ko GJ, Rhee CM, Kalantar-Zadeh K, Joshi S (August 2020). “The Effects of High-Protein Diets on Kidney Health and Longevity”. Journal of the American Society of Nephrology. 31 (8): 1667–1679. doi:10.1681/ASN.2020010028. PMC 7460905. PMID 32669325.

(5) Chung CG, Lee H, Lee SB (September 2018). “Mechanisms of protein toxicity in neurodegenerative diseases”. Cellular and Molecular Life Sciences. 75 (17): 3159–3180. doi:10.1007/s00018-018-2854-4. PMC 6063327. PMID 29947927.

(6) Godkar PB, Godkar DP. Medical Biochemistry, Theory and Practicals (1st edition, 2024), CBS Publishers, New Delhi,India.

(7) Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.

(8) Mina Khorashadi , Remi Beunders , Peter Pickkers, Matthieu Legrand.  Proenkephalin: A New Biomarker for Glomerular Filtration Rate and Acute Kidney Injury. Nephron. 2020 Jul 31;144(12):655–661. doi: 10.1159/000509352

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