Monday, January 11, 2016

Can a High Protein Breakfast Control Appetite, Calories and Blood Sugar?

Can a high protein breakfast help control appetite, calorie intake, and “blood sugar” levels all day? How much protein do we need at breakfast to achieve these effects?  

Multiple studies have suggested that protein can indeed help regulate our appetite all day, and can even help us avoid “swings” in our blood glucose levels.

An interesting study from the University of Missouri examined both issues at the same time. The paper is quite long - about 25 pages if you try to print it - and includes extensive technical details about the research, analysis, and references.  Patients often ask me to summarize research, and "translate it back into English", so I’ll try to get it down to a few paragraphs! I’ll include excerpts from the article in italics, then “translate it into English” in my own words in bold type.  First, here is the link:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334852/
Background:  Protein is generally regarded to be more satiating (filling and satisfying) than an equivalent amount of digestible carbohydrate or fat [1-4]. (Protein “tells” your brain you are full, better than carbohydrate or fat do.)  

This may be particularly true when protein is consumed at breakfast. (Despite the recent controversy in the headlines, breakfast may indeed be a key for weight loss...but it has to be the right kind of breakfast, one with protein.)
Acute intervention studies have shown that protein-rich breakfast meals reduce appetite and increase satiety throughout the morning relative to moderate or low-protein breakfast meals [6-8]. (High protein breakfasts keep you more full than lower protein breakfasts.)...
Protein-rich breakfast meals have also been shown to reduce energy intake at a subsequent ad libitum lunch meal [6,7,9-11]. (High protein breakfasts lead people to eat fewer calories at lunch -even if they aren’t counting calories,  and eat as much as they want.)
Such effects have been demonstrated at protein intakes ≥20 g, and most consistently at intakes ≥30 g of protein per meal [6,7,9-12].( 20 grams of protein at breakfast may be helpful, but 30 grams is even more likely to be effective.)
Leidy et al. [12] found that higher protein intake at breakfast (35 vs. 13 g) was associated not only with greater satiety and less hunger throughout the morning, but also with reduced energy intake from snacks in the evening hours, particularly high-fat snacks...(35 grams of protein in the morning resulted in people eating fewer calories in the evening - and particularly helped people cut down on fatty snacks.)
In addition to the satiety properties of dietary protein, the consumption of higher protein meals has been proposed to improve glucose homeostasis. (Higher protein meals may help control blood sugar.)
Several meta-analyses from long-term, higher protein, weight loss and/or weight maintenance diets report reductions in glycated hemoglobin and/or fasting insulin concentrations with higher vs. normal protein diets [14,15].  (Good quality studies have shown that higher protein diets can improve our blood sugar averages over several months, and can improve how our body uses/"burns" carbohydrates.)  
Since larger postprandial glucose elevations have been shown to be associated with an increased risk for the development of type 2 diabetes mellitus [16] and cardiovascular disease [17], it is of interest to identify dietary strategies, such as higher protein intake at breakfast... (blood sugar spikes which occur immediately after meals are particularly damaging to our bodies, and can lead to diabetes and heart disease, so it’s important to figure out how to avoid the spikes, so we can lower our risk. And breakfast protein is one way to decrease the blood sugar spikes, all day even after later meals.)
Average dietary protein intake in the US is adequate based on current recommendations [18]. However, data from the National Health and Nutrition Examination Survey (NHANES) survey suggest that the majority of dietary protein is consumed at dinner, with protein intakes at breakfast averaging ~10 g in women and 15 g in men, well below levels shown to favorably affect appetite and metabolism [19] (Timing is important.  While over the course of a day Americans may get enough protein to survive, they don’t eat enough of it in the morning, and then they eat too much at night.)
In an analysis of NHANES data, our group found that higher protein intake at breakfast was inversely associated with energy intake at lunch, and higher non-protein intake at breakfast was positively associated with energy intake at lunch [19]. (In other words, not all breakfasts are equal! High protein breakfasts led people to eat fewer calories at lunch, but low protein breakfasts led people to eat MORE at lunch!  A Poptart will make you hungry, while a high protein meal will keep you full later.  This is why some studies seem to contradict each other about the importance of breakfast.)
High protein, easy to prepare breakfast options with greater satiating potential would likely facilitate the consumption of calorically-restricted, protein-rich diets. (Simplify your protein at breakfast, and you’re more likely to succeed.)
The mechanisms whereby dietary protein promotes satiety are not completely understood. It has been hypothesized that a high-protein meal may modulate the post-absorptive release of hormones and neurochemicals in the gastrointestinal tract that down-regulate appetite [41]. In particular, consumption of high-protein meals has been shown to decrease levels of the hunger-stimulating hormone ghrelin and/or promote the increase in the satiety-stimulating hormones peptide YY (PYY) and glucagon-like peptide-1 (GLP-1), resulting in increased perceptions of satiety [8,9,26,42,43]. (We don’t know for sure WHY protein works, but we know it DOES work.  We also have some good  good leads, and research is ongoing.  But that shouldn’t stop you from doing what works!)
Conclusions
Results suggest that convenience meals providing 30 or 39 g protein/serving produce greater appetite control, lower postprandial glycemia and insulinemia, and reduced subsequent intake at lunch relative to a low-protein control, or no breakfast...
And there you have it.  Go ahead and take a look at the whole paper, and references if you have the time - it is very interesting!  My own personal experience using higher protein breakfasts, and my clinical experience with patients using this strategy, certainly is in alignment with this study.  Of course higher protein breakfasts are just one part of a healthy lifestyle strategy...but they are a great start.  
Call us any time if you’d like help creating a healthy diet plan and comprehensive lifestyle strategy to help you feel better, and be healthier.  We are here to help you get set up, then solidify your new habits so they become “second nature”, and we are here to help you “problem-solve” when new challenges come up, or if you get off track. Read more about our approach here: 
healthyweightcenter.com 

(603) 379-6500
We have some great, tasty, and convenient high protein options here: http://www.seacoastnutrition.com/

References:
Nutr J. 2015; 14: 17.Published online 2015 Feb 10. doi:  10.1186/s12937-015-0002-7 PMCID: PMC4334852 A randomized, controlled, crossover trial to assess the acute appetitive and metabolic effects of sausage and egg-based convenience breakfast meals in overweight premenopausal women
Tia M Rains,corresponding author Heather J Leidy, Kristen D Sanoshy, Andrea L Lawless, and Kevin C Maki

http://ajcn.nutrition.org/content/97/4/677.full 

Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping,” late-adolescent girls1,2,3   Collectively, these data suggest that the daily addition of breakfast, particularly one rich in protein, appears to be an appropriate strategy to improve satiety, reduce food motivation/reward, and improve diet quality by replacing unhealthy evening snacking with nutrient-rich foods at breakfast in overweight/obese teen girls.”

2013 American Society for Nutrition  

References from the first article:

References

1. Holt SH, Miller JC, Petocz P, Farmakalidis E. A satiety index of common foods. Eur J Clin Nutr.1995;49:675–90. [PubMed]
2. Stubbs J, Ferres S, Horgan G. Energy density of foods: effects on energy intake. Crit Rev Food Sci Nutr.2000;40:481–515. doi: 10.1080/10408690091189248. [PubMed] [Cross Ref]
3. Porrini M, Santangelo A, Crovetti R, Riso P, Testolin G, Blundell JE. Weight, protein, fat, and timing of preloads affect food intake. Physiol Behav. 1997;62:563–70. doi: 10.1016/S0031-9384(97)00162-5.[PubMed] [Cross Ref]
4. Johnstone AM, Stubbs RJ, Harbron CG. Effect of overfeeding macronutrients on day-to-day food intake in man. Eur J Clin Nutr. 1996;50:418–30. [PubMed]
5. Leidy HJ, Bossingham MJ, Mattes RD, Campbell WW. Increased dietary protein consumed at breakfast leads to an initial and sustained feeling of fullness during energy restriction compared to other meal times.Br J Nutr. 2009;101:798–803. doi: 10.1017/S0007114508051532. [PubMed] [Cross Ref]
6. Fallaize R, Wilson L, Gray J, Morgan LM, Griffin BA. Variation in the effects of three different breakfast meals on subjective satiety and subsequent intake of energy at lunch and evening meal. Eur J Nutr. 2013;52:1353–9. doi: 10.1007/s00394-012-0444-z. [PubMed] [Cross Ref]
7. Vander Wal JS, Marth JM, Khosla P, Jen KL, Dhurandhar NV. Short-term effect of eggs on satiety in overweight and obese subjects. J Am Coll Nutr. 2005;24:510–5. doi: 10.1080/07315724.2005.10719497.[PubMed] [Cross Ref]
8. Leidy HJ, Carnell NS, Mattes RD, Campbell WW. Higher protein intake preserves lean mass and satiety with weight loss in pre-obese and obese women. Obesity. 2007;15:421–9. doi: 10.1038/oby.2007.531.[PubMed] [Cross Ref]
9. Leidy HJ, Racki EM. The addition of a protein-rich breakfast and its effects on acute appetite control and food intake in ‘breakfast-skipping’ adolescents. Int J Obes (Lond) 2010;34:1125–33. doi: 10.1038/ijo.2010.3. [PMC free article] [PubMed] [Cross Ref]
10. Ratliff J, Leite JO, de Ogburn R, Puglisi MJ, VanHeest J, Fernandez ML. Consuming eggs for breakfast influences plasma glucose and ghrelin, while reducing energy intake during the next 24 hours in adult men. Nutr Res. 2010;30:96–103. doi: 10.1016/j.nutres.2010.01.002. [PubMed] [Cross Ref]
11. Clegg M, Shafat A. Energy and macronutrient composition of breakfast affect gastric emptying of lunch and subsequent food intake, satiety and satiation. Appetite. 2010;54:517–23. doi: 10.1016/j.appet.2010.02.005. [PubMed] [Cross Ref]
12. Leidy HJ, Ortinau LC, Douglas SM, Hoertel HA. Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping”, late-adolescent girls. Am J Clin Nutr. 2013;97:677–88. doi: 10.3945/ajcn.112.053116. [PMC free article] [PubMed] [Cross Ref]
13. Alfenas Rde C, Bressan J, Paiva AC. Effects of protein quality on appetite and energy metabolism in normal weight subjects. Arq Bras Endocrinol Metabol. 2010;54:45–51. doi: 10.1590/S0004-27302010000100008. [PubMed] [Cross Ref]
14. Dong JY, Zhang ZL, Wang PY, Qin LQ. Effects of high-protein diets on body weight, glycaemic control, blood lipids and blood pressure in type 2 diabetes: meta-analysis of randomised controlled trials.Br J Nutr. 2013;110:781–9. doi: 10.1017/S0007114513002055. [PubMed] [Cross Ref]
15. Clifton PM, Condo D, Keogh JB. Long term weight maintenance after advice to consume low carbohydrate, higher protein diets–a systematic review and meta analysis. Nutr Metab Cardiovasc Dis.2014;24:224–35. doi: 10.1016/j.numecd.2013.11.006. [PubMed] [Cross Ref]
16. Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM. The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care. 2003;26:3153. doi: 10.2337/diacare.26.11.3153. [PubMed] [Cross Ref]
17. Brunner EJ, Shipley MJ, Witte DR, Fuller JH, Marmot MG. Relation between blood glucose and coronary mortality over 33 years in the Whitehall Study. Diabetes Care. 2006;29:26–31. doi: 10.2337/diacare.29.01.06.dc05-1405. [PubMed] [Cross Ref]
18. Fulgoni VL., 3rd Current protein intake in America: analysis of the National Health and Nutrition Examination Survey, 2003–2004. Am J Clin Nutr. 2008;87:1554S–7. [PubMed]
19. Rains TM, Maki KC, Fulgoni VL, 3rd, Auestad N. Protein intake at breakfast is associated with reduced energy intake at lunch: an analysis of NHANES 2003–2006. FASEB J. 2013;27:349.7.
20. Kant AK, Graubard BI. Secular trends in patterns of self-reported food consumption of adult Americans: NHANES 1971–1975 to NHANES 1999–2002. Am J Clin Nutr. 2006;84:1215–23.[PMC free article] [PubMed]
21. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29:71–83. doi: 10.1016/0022-3999(85)90010-8.[PubMed] [Cross Ref]
22. Flint A, Raben A, Blundell JE, Astrup A. Reproducibility, power and validity of visual analogue scales in assessment of appetite sensations in single test meal studies. Int J Obes Relat Metab Disord.2000;24:38–48. doi: 10.1038/sj.ijo.0801083. [PubMed] [Cross Ref]
23. Šidák Z. On probabilities of rectangles in multivariate normal Student distributions: their dependence on correlations. Ann Math Statist. 1971;41:169–75.
24. Brouns F, Bjorck I, Frayn KN, Gibbs AL, Lang V, Slama G, et al. Glycaemic index methodology. Nutr Res Rev. 2005;18:145–71. doi: 10.1079/NRR2005100. [PubMed] [Cross Ref]
25. Meinert L, Kehlet U, Aaslyng MD. Consuming pork proteins at breakfast reduces the feeling of hunger before lunch. Appetite. 2012;59:201–3. doi: 10.1016/j.appet.2012.04.018. [PubMed] [Cross Ref]
26. Belza A, Ritz C, Sorensen MQ, Holst JJ, Rehfeld JF, Astrup A. Contribution of gastroenteropancreatic appetite hormones to protein-induced satiety. Am J Clin Nutr. 2013;97:980–9. doi: 10.3945/ajcn.112.047563. [PubMed] [Cross Ref]
27. International Food Information Council, IFIC. (2008, December 19). IFIC Review: Breakfast and Health. Retreived fromhttp://www.foodinsight.org/Content/6/IFIC%20Brkfast%20Review%20FINAL.pdf. Accessed November 6, 2012.
28. Sacks FM, Carey VJ, Anderson CAM, Miller ER, III, Copeland T, Charleston J, et al. Effects of high vs low glycemic index of dietary carbohydrate on cardiovascular disease risk factors and insulin sensitivity.JAMA. 2014;312:2531–41. doi: 10.1001/jama.2014.16658. [PMC free article] [PubMed] [Cross Ref]
29. Gannon MC, Nuttall JA, Damberg G, Gupta V, Nuttall FG. Effect of protein ingestion on the glucose appearance rate in people with type 2 diabetes. J Clin Endocrinol Metab. 2001;86:1040–7. [PubMed]
30. Anderson HG, Catherine NLA, Woodend DM, Wolever TMS. Inverse association between the effect of carbohydrates on blood glucose and subsequent short-term food intake in young men. Am J Clin Nutr.2002;76:1023–30. [PubMed]
31. Karatsoreos IN, Thaler JP, Borgland SL, Champagne FA, Hurd YL, Hill MN. Food for thought: hormonal, experiential, and neural influences on feeding and obesity. J Neurosci. 2013;33:17610–6. doi: 10.1523/JNEUROSCI.3452-13.2013. [PMC free article] [PubMed] [Cross Ref]
32. Probst A, Humpeler S, Heinzl H, Blasche G, Ekmekcioglu C. Short-term effect of macronutrient composition and glycemic index of a yoghurt breakfast on satiety and mood in healthy young men. Forsch Komplementmed. 2012;19:247–51. doi: 10.1159/000343163. [PubMed] [Cross Ref]
33. Bertenshaw EJ, Lluch A, Yeomans MR. Satiating effects of protein but not carbohydrate consumed in a between-meal beverage context. Physiol Behav. 2008;93:427–36. doi: 10.1016/j.physbeh.2007.09.014.[PubMed] [Cross Ref]
34. Dove ER, Hodgson JM, Puddey IB, Beilin LJ, Lee YP, Mori TA. Skim milk compared with a fruit drink acutely reduces appetite and energy intake in overweight men and women. Am J Clin Nutr.2009;90:70–5. doi: 10.3945/ajcn.2008.27411. [PubMed] [Cross Ref]
35. Hursel R, van der Zee L, Westerterp-Plantenga MS. Effects of a breakfast yoghurt, with additional total whey protein or caseinomacropeptide-depleted alpha-lactalbumin-enriched whey protein, on diet-induced thermogenesis and appetite suppression. Br J Nutr. 2010;103:775–80. doi: 10.1017/S0007114509992352.[PubMed] [Cross Ref]
36. Tsuchiya A, Almiron-Roig E, Lluch A, Guyonnet D, Drewnowski A. Higher satiety ratings following yogurt consumption relative to fruit drink or dairy fruit drink. J Am Diet Assoc. 2006;106:550–7. doi: 10.1016/j.jada.2006.01.004. [PubMed] [Cross Ref]
37. Bish CL, Blanck HM, Serdula MK, Marcus M, Kohl HW, 3rd, Khan LK. Diet and physical activity behaviors among Americans trying to lose weight: 2000 behavioral risk factor surveillance system. Obesity Res. 2005;13:596–607. doi: 10.1038/oby.2005.64. [PubMed] [Cross Ref]
38. Maki KC, Rains TM, Kaden VN, Raneri KR, Davidson MH. Effects of a reduced-glycemic-load diet on body weight, body composition, and cardiovascular disease risk markers in overweight and obese adults. Am J Clin Nutr. 2007;85:724–34. [PubMed]
39. Vander Wal JS, Gupta A, Khosla P, Dhurhandar NV. Egg breakfast enhances weight loss. Int J Obes (Lond) 2008;32:1545–51. doi: 10.1038/ijo.2008.130. [PMC free article] [PubMed] [Cross Ref]
40. Weigle DS, Breen PA, Matthys CC, Callahan HS, Meeuws KE, Burden VR, et al. A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. Am J Clin Nutr. 2005;82:41–8. [PubMed]
41. Bowen J, Noakes M, Trenerry C, Clifton PM. Energy intake, ghrelin, and cholecystokinin after different carbohydrate and protein preloads in overweight men. J Clin Endocrinol Metab. 2006;91:1477–83. doi: 10.1210/jc.2005-1856. [PubMed] [Cross Ref]
42. Batterham RL, Heffron H, Kapoor S, Chivers JE, Chandarana K, Herzog H, et al. Critical role for peptide YY in protein-mediated satiation and body-weight regulation. Cell Metab. 2006;4:223–33. doi: 10.1016/j.cmet.2006.08.001. [PubMed] [Cross Ref]
43. Blom WA, Lluch A, Stafleu A, Vinoy S, Holst JJ, Schaafsma G, et al. Effect of a high-protein breakfast on the postprandial ghrelin response. Am J Clin Nutr. 2006;83:211–20. [PubMed]
44. Schloegl H, Percik R, Horstmann A, Villringer A, Stumvoll M. Peptide hormones regulating appetite–focus on neuroimaging studies in humans. Diabetes Metab Res Rev. 2011;27:104–12. doi: 10.1002/dmrr.1154. [PubMed] [Cross Ref]
45. Holt SH, Miller JB. Increased insulin responses to ingested foods are associated with lessened satiety.Appetite. 1995;24:43–54. doi: 10.1016/S0195-6663(95)80005-0. [PubMed] [Cross Ref]
46. Leidy HJ, Apolzan JW, Mattes RD, Campbell WW. Food form and portion size affect postprandial appetite sensations and hormonal responses in healthy, nonobese, older adults. Obesity. 2010;18:293–9. doi: 10.1038/oby.2009.217. [PMC free article] [PubMed] [Cross Ref]
47. Sobrino Crespo C, Perianes Cachero A, Puebla Jimenez L, Barrios V, Arilla Ferreiro E. Peptides and food intake. Front Endocrinol. 2014;5:58. doi: 10.3389/fendo.2014.00058. [PMC free article] [PubMed][Cross Ref]
48. Crovetti R, Porrini M, Santangelo A, Testolin G. The influence of thermic effect of food on satiety. Eur J Clin Nutr. 1998;52:482–8. doi: 10.1038/sj.ejcn.1600578. [PubMed] [Cross Ref]
49. Veldhorst M, Smeets A, Soenen S, Hochstenbach-Waelen A, Hursel R, Diepvens K, et al. Protein-induced satiety: effects and mechanisms of different proteins. Physiol Behav. 2008;94:300–7. doi: 10.1016/j.physbeh.2008.01.003. [PubMed] [Cross Ref]
50. Blundell J, de Graaf C, Hulshof T, Jebb S, Livingstone B, Lluch A, et al. Appetite control: methodological aspects of the evaluation of foods. Obes Rev. 2010;11:251–70. doi: 10.1111/j.1467-789X.2010.00714.x. [PMC free article] [PubMed] [Cross Ref]
51. Williams RA, Roe LS, Rolls BJ. Assessment of satiety depends on the energy density and portion size of the test meal. Obesity. 2014;22:318–24. doi: 10.1002/oby.20589. [PMC free article] [PubMed][Cross Ref]

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