Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

How Much Protein Do You Really Need?

Have you ever thought about how much protein you are supposed to get each day? The answer to that question is not as black and white as you may think.

The Recommended Dietary Allowance (RDA) for protein is set at 0.8 grams (g) per kilogram (kg) of body weight. In order to figure out your weight in kg, divide your weight in pounds by 2.2. So if you weigh 150 pounds (68.2 kg), you need about 55 grams of protein. You can also use 0.36 grams per pound of body weight if you don’t want to convert to kg.

The RDA is set at a level of what you need to prevent deficiency. But many researchers believe that we actually need more than that for reasons of muscle building and for optimal satiety (to keep us full).

Here are some other recommendations:

Pregnancy/lactation: 1.1 g per kg body weight (0r 0.5 grams per pound). You can use pre-pregnancy weight for the calculation. The point is you need significantly more protein when pregnant. Add 25 grams more per day if you are carrying multiples. This extra protein is especially important in the second half and third trimester. You can also use 0.55 grams per pound body weight to calculate.

Endurance athletes: 1.2-1.4 g per kg body weight (or 0.55-0.65 grams per pound). Endurance athletes often think of carbs, carbs, carbs, and they ignore protein. But you are using your muscles quite a bit and need extra protein to repair them. Endurance athletes would be runners, bikers, long distance swimming, etc.

Strength athletes: 1.6-1.7 g per kg body weight (or 0.73-0.77 grams per pound). Strength athletes are pushing their muscles to the extreme and need more protein to build and repair those muscles. But don’t skimp on carbs because your body will break down protein for energy if you don’t get enough carbs. Strength athletes are people who do a signficant amount of strength training and may lift very heavy weights.

An upper limit of protein has not really been established, but many researchers believe that the body cannot use much more than 1 gram of protein per pound body weight.

This post, How Much Protein Do You Really Need?, was originally published on by Brian Westphal.

Back To Basics: How Much Protein Do You Need To Eat?

It is estimated that 75% of our healthcare dollars are spent on chronic disease management, and that 80% of chronic diseases could be avoided with diet and lifestyle interventions. This means that the best way to decrease the size of our healthcare budget is to decrease the size of our collective waistlines. And that’s no small task.

Going back to basics – healthy eating and regular exercise – is such a simple message. But what is healthy eating exactly?  Consumers are fairly exhausted by the complex messages they’ve heard about food and nutrition over the past couple of decades. One minute anti-oxidant foods are a miracle cure for everything from cancer to facial wrinkles, the next, it seems that they actually increase the risk of death.  Diet advice ranging from low fat, low carb, to low sugar have all been promoted as the healthiest way to lose weight. But what does the evidence actually show? I decided to interview a series of experts to try to glean what I could about the state of nutrition knowledge. Today’s post is about protein – and I interviewed Nancy Rodriguez, PhD, a “protein scientist” to weigh in on this nutrient.

Dr. Val: We don’t talk about dietary protein needs that much, Nancy. Why is that?

Dr. Rodriguez: In the United States most people do get at least the minimum required amount of protein/day.  The RDA (recommended daily allowance) of 0.8g/Kg of body weight is the amount you need to consume to avoid an outright protein deficiency. That’s about 3 ounces of chicken, fish, or meat/day – the size of a deck of cards. But the real benefits of protein include appetite suppression, and thermogenesis. Studies show that if people eat a little bit of protein with each meal, they’re less likely to become hungry between meals or consume as many calories overall. You also end up burning a few calories in the process of digesting protein.

Dr. Val: So what is the appropriate amount of protein intake?

Dr. Rodriguez: I have found that 1.2-1.5g/Kg may be optimal for hunger management. That means we should try to get a little bit of protein with each meal. Weight maintenance and loss is much easier to achieve if you don’t feel hungry all the time. Protein can really help with that.

Dr. Val: Is it possible to eat too much protein? Can it damage the kidneys in excess?

Dr. Rodriguez: I’ve conducted a few studies with participants eating 3g/kg  of protein. That’s really hard to do. For example, you have to eat eggs and bacon for breakfast, 2 chicken breasts and veggies for lunch, and a 10oz steak for dinner. This is clearly in excess of what we need, though it’s hard to say if that level of protein is harmful. If someone has kidney disease, then obviously it would be a really bad idea to tax the kidneys with removing so many protein break down products. But people with normal kidney function didn’t seem to have a problem clearing the protein. Protein isn’t stored. When you consume more of it than your body needs, it is simply broken down and removed via the urine.

I personally don’t believe that excess protein causes kidney disease, but it can be a problem for those who have kidney disease. We would have to do some very long term studies of people eating very high protein diets for decades to find out if they end up with a higher risk of kidney disease. We just don’t know yet. But our kidneys have a tremendous reserve capacity to filter the blood. We can easily live with just one kidney – so it’s possible that healthy kidneys can handle high protein diets without injury. One thing that I certainly recommend – if you eat a lot of protein, you should drink a lot of water to help to flush out the break down products.

Dr. Val: Is it true that whey protein may help to reduce high blood pressure?

Dr. Rodriguez: Milk proteins are very interesting in that they contain a broad array of bioactive substances. There is increasing evidence that lactokinins can reduce blood pressure, but we just don’t understand the exact mechanism yet. We do know that people who eat more dairy products (included in the DASH diet plan) can lower their systolic blood pressure by an average of 10 mmHg.

Whey protein is also a natural appetite suppressant, so it can be helpful part of a weight loss strategy. Dairy sources of protein are an important part of a healthy diet.


I caught up with Nancy at the Dairy Science Forum on November 13th, 2008 in Washington, DC.

Photo of Nancy Rodriguez

Nancy Rodriguez

Nancy Rodriguez, PhD, RD, CSSD, FACSM,  is a professor of Nutritional Sciences in the College of Agriculture and Natural Resources (CANR) at the University of Connecticut, with joint appointments in the Departments of Kinesiology and Allied Health Sciences. She is director of Sports Nutrition in the Department of Sports Medicine in the Division of Athletics.

How Much Vitamin D Does Your Child Need?

Tanya Altmann, MD

It’s been a little while since I had a “blonde moment” during an expert interview, but this one was pretty funny. I was in the middle of a podcast with Dr. Tanya Altmann, media personality and spokesperson for the American Academy of Pediatrics, about vitamin D – when I thought I heard her say that there were now special formulas of vitamin D for incense.

I knew that Dr. Altmann practiced medicine in Southern California, so I wasn’t terribly surprised about this new method of vitamin delivery. However, I hadn’t heard about vitamin D inhalation previously, so I asked her to explain how this new incense formula worked.

She paused to gather her thoughts and then corrected me: “No, I was saying that there’s a new formula for INFANTS…”

Oh. My bad.

So here’s the rest of our delightful interview. You may want to listen to the podcast, though I did edit out the awkward “incense” section so as not to start a new cult. One doesn’t want to give others too many ideas on the Internet! I hope that Dr. Tanya won’t think less of me for that misunderstanding.

Dr. Val: What is vitamin D, and why do we need it?

Dr. Tanya: Vitamin D is an essential nutrient for your entire body. Although it’s called a vitamin it actually functions as more of a hormone, playing an important role in the immune system. Vitamin D can help to protect people against illness, diabetes, and even cancer, though its role in helping to build strong bones (and protect infants from rickets) is probably its best known attribute.

Dr. Val: Tell me about the new AAP guidelines for infants, children and adolescents. Why did they change?

Dr. Tanya: Based on data collected in several recent research studies, the American Academy of Pediatrics issued new guidelines last month which essentially doubled the recommended daily amount of vitamin D (from 200 to 400 IUs) for infants, children, and adolescents. Historically people were able to get sufficient amounts of vitamin D through sun exposure (the body can create vitamin D when the skin is exposed to sunlight), but now that we need to protect kids from sun’s harmful rays due to future skin cancer risk, vitamin D levels have dropped significantly. Sunscreen, of course, blocks the sun from stimulating the creation of vitamin D in the skin. Read more »

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

See all interviews »

Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


Click here for a musical take on over-testing.

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »