Protein on Keto: How Much is Too Much? with Dr. Bret Scher

Bret: 
If you’re following a ketogenic diet or utilizing ketogenic therapy to treat your diabetes or depression or bipolar disorder, schizophrenia or other brain-based disorders, you’ve likely heard someone say that you shouldn’t eat too much protein or that you should eat a moderate amount of protein. But what exactly does that mean?

The good news is that it doesn’t have to be confusing. In fact, it can be quite easy to find the right amount of protein. So, let’s talk about these definitions, and how to measure if someone’s in the right protein range.

Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a nonprofit initiative of Baszucki Group where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies, such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

As I mentioned, finding the right level of protein doesn’t have to be confusing. But before we get into the details, please remember our channels for informational purposes only. We’re not providing individual or group medical or healthcare advice or establishing a provider patient relationship. Many of the interventions we discuss can have potentially dangerous effects of done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. In addition, please recognize that people may respond differently to ketosis and there isn’t one universal response.

Okay, so let’s start with the basics. We often hear about the RDA or the recommended daily allowance for protein, which is 0.8 grams per kilogram of reference body weight.

So real quick, reference body weight, also called ideal body weight, is based on someone’s height ,basically. So, if your weight or your body mass index is in the quote unquote normal range, then you can just use your actual weight. But if you’re in the overweight or obese range, then you shouldn’t use your actual weight, but rather refer to the table we link to in the description to find your reference body weight.

For example, a five foot eight inch male. His reference weights between 145 and 157 pounds, and a woman of the same height would be between 136 and 150 pounds. Here’s the key with the RDA. It’s the minimum recommendation to prevent serious protein deficiency, and it’s meant for sedentary individuals.

So, it’s not meant for teenagers or pregnant women, the elderly, or anyone really physically active, and it’s not the goal if someone is looking to improve metabolic health or lean muscle mass. So, right away we can see that the RDA is not the goal for the vast majority of people. Also, the RDA references high-quality protein intake.

So high-quality means animal protein sources and soy. So, other plant sources are less bio-available, meaning we absorb less and use less. So, we need a higher intake to achieve the same effect as we would with animal protein. But first, let’s start with the question, why would someone want to eat more protein?

And well, studies indicate that higher protein intake can help with satiety or feeling full. For instance, those who ate a higher protein breakfast ate fewer calories during the rest of the day than those who ate lower protein breakfast. And there are other studies like this, and we’ll link to a guide in the description with more details. But also higher protein intake helps build or maintain muscle mass and can help improve bone health.

And can improve blood glucose usage and metabolic health since muscle is a very metabolically active tissue. But too much protein can trigger an insulin response or even slightly raise blood sugar through a process called gluconeogenesis. And this could potentially lower ketone levels in some individuals.

So, what is the goal protein intake for someone using ketogenic therapy? And actually, let me stop because I want to emphasize we’re talking about ketogenic therapy. You can watch our prior video about the differences between a keto diet and ketogenic therapy. So, this discussion may not apply to everyone in a keto diet, but is geared towards those on ketogenic therapy.

Now, most experts in the field recommend starting with 1.0 to 1.2 grams per kilogram. So, for example, a woman who’s five foot five inches tall, it’s around 68 grams per day. And it comes down to assessing if higher levels would be beneficial for that individual, again, for satiety weight loss, building muscle mass, and improving metabolic.

In those cases, they may recommend increasing to 1.4 grams per kilogram, around 86 grams of protein, for the same individual as long as the ketones remain in the appropriate range. And as I mentioned before, this is based on high-quality protein, animal protein, and soy. So, other forms of protein would require even higher levels. And teenagers, physically active individuals and the elderly may require even more.

But, for reference, here’s an example of a hundred grams of protein per day from a guide from dietdoctor.com. You can see for breakfast, three eggs and one ounce of cheese. For lunch, four and a half ounces of salmon. And chicken, five ounces at dinner. So, that should be doable for most people to reach that level.

But how do you know if you’re eating too much? That’s the big question so many people on ketogenic therapy have. And luckily, with ketone testing, the answer’s pretty easy. Nowadays, it’s pretty simple to monitor ketone levels with a finger stick device, like Keto Mojo or other brands, or breath device, like Biosense or other brands.

So, someone could start at, say, 1.2 grams per kilogram and monitor their ketone levels. Then, if they wanted to, they could increase to 1.4 grams per kilogram and see how it affects their ketone levels. If they see their ketones drop, then they know they’ve hit their limit. Again, for weight loss, it may not matter so much, but for ketogenic therapy it could be a big deal.

And that’s why it’s important that each individual work with their healthcare team to set target ketone levels and design a diet and lifestyle to achieve those targets. And those targets may be moving. They may not be static depending on the medical condition someone’s treating, and how they progress over time.

We know it’s not always easy to find a healthcare team who’s well-versed in ketogenic therapy. So, you can watch our other video on this topic as well to learn more. Okay, now two more quick issues. First, what about protein intake and longevity? That’s a bigger topic that deserves its own video. But in brief, there’s really no high-quality evidence that shows lower protein intake improves longevity in humans.

The data is mostly low-quality observational data or animal data. And especially, if someone’s using protein as a tool to improve metabolic health and lean muscle mass, then it’s likely to be much more beneficial than harmful. Again, we’ll link to a more detailed article in the description. And then what about plant versus animal sources of protein?

First, as I mentioned, animal sources are higher quality, meaning more bio-available and tend to come with fewer calories and carbohydrates compared to plant sources. People can still achieve all their protein goals with plant sources, especially soy. But for other plant sources, they need the right mix to get adequate amounts of all essential amino acids and will likely need a higher total amount of protein.

Something that’s totally doable. But when trying to maintain ketosis, the carbs may add up quickly. So, that’s something to pay attention to. But are plant sources healthier than animal sources? Again, the data come from low-quality observational nutrition epidemiology studies, which we’ve covered before about the difficulty using that low-quality data for an individual, especially someone who’s using ketogenic therapy to treat a medical condition.

So, we would say that the jury is still out about plant protein being healthier for someone using ketogenic therapy. And the key is finding the protein sources that someone’s going to enjoy and stay with as part of their ketogenic therapy.

So, in conclusion, most people can ignore the RDA as it’s far too low for their purposes. Most ketogenic therapy experts recommend starting at 1.0 to 1.2 grams per kilogram of reference body weight and potentially increasing from there for satiety, muscle mass, improving metabolic health while continuing to monitor ketone levels to ensure stability.

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