©Journal of Sports Science and Medicine (2019) 3, 118-130

http://www.jssm.org

Review article

International Society of Sports Nutrition Symposium, June 18-19, 2018, Las Vegas
NV,
USA - Symposium - Macronutrient Utilization During Exercise: Implications For
Performance And Supplementation

PROTEIN – WHICH IS BEST?

Jay R. Hoffman  and Michael J. Falvo

The Department of Health and Exercise Science, The College of New Jersey, Ewing, New Jersey, USA

Received: 26 May 2019 / Accepted: 28 June 2019 / Published (online): 01 September 2019

ABSTRACT
Protein intake that exceeds the recommended daily allowance is widely accepted for both endurance and
power athletes. However, considering the variety of proteins that are available much less is known
concerning the benefits of consuming one protein versus another. The purpose of this paper is to identify
and analyze key factors in order to make responsible recommendations to both the general and athletic
populations. Evaluation of a protein is fundamental in determining its appropriateness in the human diet.
Proteins that are of inferior content and digestibility are important to recognize and restrict or limit in the
diet. Similarly, such knowledge will provide an ability to identify proteins that provide the greatest
benefit and should be consumed. The various techniques utilized to rate protein will be discussed.
Traditionally, sources of dietary protein are seen as either being of animal or vegetable origin. Animal
sources provide a complete source of protein (i.e. containing all essential amino acids), whereas
vegetable sources generally lack one or more of the essential amino acids. Animal sources of dietary
protein, despite providing a complete protein and numerous vitamins and minerals, have some health
professionals concerned about the amount of saturated fat common in these foods compared to vegetable
sources. The advent of processing techniques has shifted some of this attention and ignited the sports
supplement marketplace with derivative products such as whey, casein and soy. Individually, these
products vary in quality and applicability to certain populations. The benefits that these particular
proteins possess are discussed. In addition, the impact that elevated protein consumption has on health
and safety issues (i.e. bone health, renal function) are also reviewed.

KEY WORDS: Sport supplementation, ergogenic aid, animal protein, vegetable protein.

population become generally accepted. In addition,

high protein diets have also become quite popular
INTRODUCTION in the general population as part of many weight
reduction programs. Despite the prevalence of high
The protein requirements for athletic populations protein diets in athletic and sedentary populations,
have been the subject of much scientific debate. information available concerning the type of
Only recently has the notion that both protein (e.g. animal or vegetable) to consume is
strength/power and endurance athletes require a limited. The purpose of this paper is to examine
greater protein consumption than the general and analyze key factors responsible for making
119 Hoffman and Falvo

appropriate choices on the type of protein to 2.4 g⋅kg-1⋅day-1 will maintain a positive nitrogen
consume in both athletic and general populations. balance in resistance trained athletes (Lemon,
1995). As a result, recommendations for
Role of Protein strength/power athletes’ protein intake are
generally suggested to be between 1.4 - 1.8 g⋅kg-
Proteins are nitrogen-containing substances that are 1
⋅day-1.
formed by amino acids. They serve as the major Similarly, to prevent significant losses in lean
structural component of muscle and other tissues in tissue endurance athletes also appear to require a
the body. In addition, they are used to produce greater protein consumption (Lemon, 1995).
hormones, enzymes and hemoglobin. Proteins can Although the goal for endurance athletes is not
also be used as energy; however, they are not the necessarily to maximize muscle size and strength,
primary choice as an energy source. For proteins to loss of lean tissue can have a significant
be used by the body they need to be metabolized detrimental effect on endurance performance.
into their simplest form, amino acids. There have Therefore, these athletes need to maintain muscle
been 20 amino acids identified that are needed for mass to ensure adequate performance. Several
human growth and metabolism. Twelve of these studies have determined that protein intake for
amino acids (eleven in children) are termed endurance athletes should be between 1.2 – 1.4
nonessential, meaning that they can be synthesized g⋅kg-1⋅day-1 to ensure a positive nitrogen balance
by our body and do not need to be consumed in the (Freidman and Lemon, 1989; Lemon, 1995;
diet. The remaining amino acids cannot be Meredith et al., 1989; Tarnopolsky et al., 1988).
synthesized in the body and are described as Evidence is clear that athletes do benefit from
essential meaning that they need to be consumed in increased protein intake. The focus then becomes
our diets. The absence of any of these amino acids on what type of protein to take.
will compromise the ability of tissue to grow, be
repaired or be maintained.
Protein Assessment
Protein and Athletic Performance
The composition of various proteins may be so
unique that their influence on physiological
The primary role of dietary proteins is for use in function in the human body could be quite
the various anabolic processes of the body. As a different. The quality of a protein is vital when
result, many athletes and coaches are under the considering the nutritional benefits that it can
belief that high intensity training creates a greater provide. Determining the quality of a protein is
protein requirement. This stems from the notion determined by assessing its essential amino acid
that if more protein or amino acids were available composition, digestibility and bioavailability of
to the exercising muscle it would enhance protein amino acids (FAO/WHO, 1990). There are several
synthesis. Research has tended to support this measurement scales and techniques that are used to
hypothesis. Within four weeks of protein evaluate the quality of protein.
supplementation (3.3 versus 1.3 g⋅kg-1⋅day-1) in
subjects’ resistance training, significantly greater Protein Rating Scales
gains were seen in protein synthesis and body Numerous methods exist to determine protein
mass in the group of subjects with the greater quality. These methods have been identified as
protein intake (Fern et al., 1991). Similarly, protein efficiency ratio, biological value, net
Lemon et al. (1992) also reported a greater protein protein utilization, and protein digestibility
synthesis in novice resistance trained individuals corrected amino acid score.
with protein intakes of 2.62 versus 0.99 g⋅kg-
1
⋅day-1. In studies examining strength-trained Protein Efficiency Ratio
individuals, higher protein intakes have generally The protein efficiency ratio (PER) determines the
been shown to have a positive effect on muscle effectiveness of a protein through the measurement
protein synthesis and size gains (Lemon, 1995; of animal growth. This technique requires feeding
Walberg et al., 1988). Tarnapolsky and colleagues rats a test protein and then measuring the weight
(1992) have shown that for strength trained gain in grams per gram of protein consumed. The
individuals to maintain a positive nitrogen balance computed value is then compared to a standard
they need to consume a protein intake equivalent value of 2.7, which is the standard value of casein
to 1.8 g⋅kg-1⋅day-1. This is consistent with other protein. Any value that exceeds 2.7 is considered
studies showing that protein intakes between 1.4 – to be an excellent protein source. However, this
 Protein ratings 120

calculation provides a measure of growth in rats Net Protein Utilization

and does not provide a strong correlation to the Net protein utilization is similar to the biological
growth needs of humans. value except that it involves a direct measure of
retention of absorbed nitrogen. Net protein
Biological Value utilization and biological value both measure the
Biological value measures protein quality by same parameter of nitrogen retention, however, the
calculating the nitrogen used for tissue formation difference lies in that the biological value is
divided by the nitrogen absorbed from food. This calculated from nitrogen absorbed whereas net
product is multiplied by 100 and expressed as a protein utilization is from nitrogen ingested.
percentage of nitrogen utilized. The biological
value provides a measurement of how efficient the Protein Digestibility Corrected Amino Acid Score
body utilizes protein consumed in the diet. A food In 1989, the Food & Agriculture Organization and
with a high value correlates to a high supply of the
Protein Protein Biological Net Protein Protein Digestibility
Type Efficiency Value Utilization Corrected Amino Acid
Ratio Score
Beef 2.9 80 73 0.92
Black Beans 0 0 0.75
Casein 2.5 77 76 1.00
Egg 3.9 100 94 1.00
Milk 2.5 91 82 1.00
Peanuts 1.8 0.52
Soy protein 2.2 74 61 1.00
Wheat gluten 0.8 64 67 0.25
Whey protein 3.2 104 92 1.00
Table 1. Protein quality rankings.

Adapted from: U.S Dairy Export Council, Reference Manual for U.S. Whey Products 2nd Edition,
essential 1999 and Sarwar, 1997. World Health Organization (FAO/WHO) in a joint
position stand stated that protein quality could be
amino acids. Animal sources typically possess a determined by expressing the content of the first
higher biological value than vegetable sources due limiting essential amino acid of the test protein as a
to the vegetable source’s lack of one or more of the percentage of the content of the same amino acid
essential amino acids. There are, however, some content in a reference pattern of essential amino
inherent problems with this rating system. The acids (FAO/WHO, 1990). The reference values
biological value does not take into consideration used were based upon the essential amino acids
several key factors that influence the digestion of requirements of preschool-age children. The
protein and interaction with other foods before recommendation of the joint FAO/WHO statement
absorption. The biological value also measures a was to take this reference value and correct it for
protein’s maximal potential quality and not its true fecal digestibility of the test protein. The value
estimate at requirement levels. obtained was referred to as the protein digestibility
corrected amino acid score (PDCAAS). This
method has been adopted as the preferred method
for measurement of the protein value in human
121 Hoffman and Falvo

nutrition (Schaafsma, 2000). Table 1 provides a legumes to ensure consumption of all essential
measure of the quantity of various proteins using amino acids. As such, individuals are able to
these protein rating scales. achieve necessary protein requirements without
Although the PDCAAS is currently the most consuming beef, poultry, or dairy. Protein
accepted and widely used method, limitations still digestibility ratings usually involve measuring how
exist relating to overestimation in the elderly (likely the body can efficiently utilize dietary sources of
related to references values based on young protein. Typically, vegetable protein sources do not
individuals), influence of ileal digestibility, and score as high in ratings of biological value, net
antinutritional factors (Sarwar, 1997). protein utilization, PDCAAS, and protein
Amino acids that move past the terminal efficiency ratio as animal proteins.
ileum may be an important route for bacterial
consumption of amino acids, and any amino acids Animal Protein
that reach the colon would not likely be utilized for Proteins from animal sources (i.e. eggs, milk, meat,
protein synthesis, even though they do not appear fish and poultry) provide the highest quality rating
in the feces (Schaarfsma, 2000). Thus, to get truly of food sources. This is primarily due to the
valid measure of fecal digestibility the location at ‘completeness’ of proteins from these sources.
which protein synthesis is determined is important Although protein from these sources are also
in making a more accurate determination. Thus, associated with high intakes of saturated fats and
ileal digestibility would provide a more accurate cholesterol, there have been a number of studies
measure of digestibility. PDCAAS, however, does that have demonstrated positive benefits of animal
not factor ileal digestibility into its equation. This is proteins in various population groups (Campbell et
considered to be one of the shortcomings of the al., 1999; Godfrey et al., 1996; Pannemans et al.,
PDCAAS (Schaafsma 2000). 1998).
Antinutritional factors such as trypsin Protein from animal sources during late
inhibitors, lectins, and tannins present in certain pregnancy is believed to have an important role in
protein sources such as soybean meal, peas and infants born with normal body weights. Godfrey et
fava beans have been reported to increase losses of al. (1996) examined the nutrition behavior of more
endogenous proteins at the terminal ileum (Salgado than 500 pregnant women to determine the effect of
et al., 2002). These antinutritional factors may nutritional intake on placental and fetal growth.
cause reduced protein hydrolysis and amino acid They reported that a low intake of protein from
absorption. This may also be more effected by age, dairy and meat sources during late pregnancy was
as the ability of the gut to adapt to dietary associated with low birth weights.
nutritional insults may be reduced as part of the In addition to the benefits from total protein
aging process (Sarwar, 1997). consumption, elderly subjects have also benefited
from consuming animal sources of protein. Diets
Protein Sources consisting of meat resulted in greater gains in lean
body mass compared to subjects on a
Protein is available in a variety of dietary sources. lactoovovegetarian diet (Campbell et al., 1999).
These include foods of animal and plant origins as High animal protein diets have also been shown to
well as the highly marketed sport supplement cause a significantly greater net protein synthesis
industry. In the following section proteins from than a high vegetable protein diet (Pannemans et
both vegetable and animal sources, including whey, al., 1998). This was suggested to be a function of
casein, and soy will be explored. Determining the reduced protein breakdown occurring during the
effectiveness of a protein is accomplished by high animal protein diet.
determining its quality and digestibility. Quality There have been a number of health concerns
refers to the availability of amino acids that it raised concerning the risks associated with protein
supplies, and digestibility considers how the emanating primarily from animal sources.
protein is best utilized. Typically, all dietary animal Primarily, these health risks have focused on
protein sources are considered to be complete cardiovascular disease (due to the high saturated fat
proteins. That is, a protein that contains all of the and cholesterol consumption), bone health (from
essential amino acids. Proteins from vegetable bone resorption due to sulfur-containing amino
sources are incomplete in that they are generally acids associated with animal protein) and other
lacking one or two essential amino acids. Thus, physiological system disease that will be addressed
someone who desires to get their protein from in the section on high protein diets.
vegetable sources (i.e. vegetarian) will need to
consume a variety of vegetables, fruits, grains, and
 Protein ratings 122

Whey safely take these products (Geiser, 2003).

Whey is a general term that typically denotes the Although the concentration of protein in this form
translucent liquid part of milk that remains of whey protein is the highest, it often contain
following the process (coagulation and curd proteins that have become denatured due to the
removal) of cheese manufacturing. From this manufacturing process. The denaturation of
liquid, whey proteins are separated and purified proteins involves breaking down their structure
using various techniques yielding different and losing peptide bonds and reducing the
concentrations of whey proteins. Whey is one of effectiveness of the protein.
the two major protein groups of bovine milk,
accounting for 20% of the milk while casein Table 2. Composition (%) of whey protein forms.
accounts for the remainder. All of the constituents Component Whey Whey Whey
of whey protein provide high levels of the essential Powder Concentrate Isolate
and branched chain amino acids. The bioactivities Protein 11 – 14.5 25 – 89 90 +
of these proteins possess many beneficial properties Lactose 63 – 75 10 – 55 0.5
as well. Additionally, whey is also rich in vitamins Milk Fat 1 – 1.5 2 – 10 0.5
and minerals. Whey protein is most recognized for Adapted from Geiser, 2003.
its applicability in sports nutrition. Additionally,
whey products are also evident in baked goods,
Whey is a complete protein whose
salad dressings, emulsifiers, infant formulas, and
biologically active components provide additional
medical nutritional formulas.
benefits to enhance human function. Whey protein
contains an ample supply of the amino acid
Varieties of Whey Protein cysteine. Cysteine appears to enhance glutathione
There are three main forms of whey protein that levels, which has been shown to have strong
result from various processing techniques used to antioxidant properties that can assist the body in
separate whey protein. They are whey powder, combating various diseases (Counous, 2000). In
whey concentrate, and whey isolate. Table 2 addition, whey protein contains a number of other
provides the composition of Whey Proteins. proteins that positively effect immune function
such as antimicrobial activity (Ha and Zemel,
Whey Protein Powder 2003). Whey protein also contains a high
Whey protein powder has many applications concentration of branched chain amino acids
throughout the food industry. As an additive it is (BCAA) that are important for their role in the
seen in food products for beef, dairy, bakery, maintenance of tissue and prevention of catabolic
confectionery, and snack products. Whey powder actions during exercise.
itself has several different varieties including sweet (MacLean et al., 1994).
whey, acid whey (seen in salad dressings),
demineralized (seen primarily as a food additive Casein
including infant formulas), and reduced forms. The Casein is the major component of protein found in
demineralized and reduced forms are used in bovine milk accounting for nearly 70-80% of its
products other than sports supplements. total protein and is responsible for the white color
of milk. It is the most commonly used milk
Whey Protein Concentrate protein in the industry today. Milk proteins are of
The processing of whey concentrate removes the significant physiological importance to the body
water, lactose, ash, and some minerals. In addition, for functions relating to the uptake of nutrients
compared to whey isolates whey concentrate and vitamins and they are a source of biologically
typically contains more biologically active active peptides. Similar to whey, casein is a
components and proteins that make them a very complete protein and also contains the minerals
attractive supplement for the athlete. calcium and phosphorous. Casein has a PDCAAS
rating of 1.23 (generally reported as a truncated
Whey Protein Isolate (WPI) value of 1.0) (Deutz et al. 1998).
Isolates are the purest protein source available. Casein exists in milk in the form of a
Whey protein isolates contain protein micelle, which is a large colloidal particle. An
concentrations of 90% or higher. During the attractive property of the casein micelle is its
processing of whey protein isolate there is a ability to form a gel or clot in the stomach. The
significant removal of fat and lactose. As a result, ability to form this clot makes it very efficient in
individuals who are lactoseintolerant can often nutrient supply. The clot is able to provide a
123 Hoffman and Falvo

sustained slow release of amino acids into the phytochemicals and fiber that are also highly
blood stream, sometimes lasting for several hours regarded in the diet diet.
(Boirie et al. 1997). This provides better nitrogen
retention and utilization by the body. Soy
Soy is the most widely used vegetable protein
Bovine Colostrum source. The soybean, from the legume family,
Bovine colostrum is the “pre” milk liquid secreted was first chronicled in China in the year 2838
by female mammals the first few days following B.C. and was considered to be as valuable as
birth. This nutrient-dense fluid is important for the wheat, barley, and rice as a nutritional staple.
newborn for its ability to provide immunities and Soy’s popularity spanned several other countries,
assist in the growth of developing tissues in the but did not gain notoriety for its nutritional value
initial stages of life. Evidence exists that bovine in The United States until the 1920s. The
colostrum contains growth factors that stimulate American population consumes a relatively low
cellular growth and DNA synthesis (Kishikawa et intake of soy protein (5g · day -1) compared to
al., 1996), and as might be expected with such Asian countries (Hasler, 2002). Although cultural
properties, it makes for interesting choice as a differences may be partly responsible, the low
potential sports supplement. protein quality rating from the PER scale may also
Although bovine colostrum is not typically have influenced protein consumption tendencies.
thought of as a food supplement, the use by However, when the more accurate PDCAAS scale
strength/power athletes of this protein supplement is used, soy protein was reported to be equivalent
as an ergogenic aid has become common. Oral to animal protein with a score of 1.0, the highest
supplementation of bovine colostrum has been possible rating (Hasler, 2002). Soy’s quality
demonstrated to significantly elevate insulin- makes it a very attractive alternative for those
likegrowth factor 1 (IGF-1) (Mero et al., 1997) and seeking non-animal sources of protein in their diet
enhance lean tissue accruement (Antonio et al., and those who are lactose intolerant. Soy is a
2001; Brinkworth et al., 2004). However, the complete protein with a high concentration of
results on athletic performance improvement are BCAA’s. There have been many reported benefits
less conclusive. Mero and colleagues (1997) related to soy proteins relating to health and
reported no changes in vertical jump performance performance (including reducing plasma lipid
following 2weeks of supplementation, and profiles, increasing LDL-cholesterol oxidation and
Brinkworth and colleagues (2004) saw no reducing blood pressure), however further
significant differences in strength following 8- research still needs to be performed on these
weeks of training and supplementation in both claims.
trained and untrained subjects. In contrast,
following 8-weeks of supplementation significant Soy Protein Types
improvements in sprint performance were seen in The soybean can be separated into three distinct
elite hockey players (Hofman et al., 2002). Further categories; flour, concentrates, and isolates. Soy
research concerning bovine colostrum flour can be further divided into natural or full-fat
supplementation is still warranted. (contains natural oils), defatted (oils removed),
and lecithinated (lecithin added) forms (Hasler,
Vegetable Protein 2002). Of the three different categories of soy
Vegetable proteins, when combined to provide for protein products, soy flour is the least refined
all of the essential amino acids, provide an form. It is commonly found in baked goods.
excellent source for protein considering that they Another product of soy flour is called textured soy
will likely result in a reduction in the intake of flour. This is primarily used for processing as a
saturated fat and cholesterol. Popular sources meat extender. See Table 3 for protein
include legumes, nuts and soy. Aside from these composition of soy flour, concentrates, and
products, vegetable protein can also be found in a isolates.
fibrous form called textured vegetable protein
(TVP). TVP is produced from soy flour in which Table 3. Protein composition of soy protein forms.
proteins are isolated. TVP is mainly a meat Soy Protein Form Protein Composition
alternative and functions as a meat analog in Soy Flour 50%
vegetarian hot dogs, hamburgers, chicken patties, Soy Concentrate 70%
etc. It is also a low-calorie and low-fat source of Soy Isolate 90%
vegetable protein. Vegetable sources of protein also
provide numerous other nutrients such as
 Protein ratings 124

Soy concentrate was developed in the late that isoflavones are considered phytoestrogens
1960s and early 1970s and is made from defatted (exhibit estrogen- like effects and bind to estrogen
soybeans. While retaining most of the bean’s receptors) they compete for estrogen receptor sites
protein content, concentrates do not contain as in breast tissue with endogenous estrogen,
much soluble carbohydrates as flour, making it potentially reducing the risk for breast cancer risk
more palatable. Soy concentrate has a high (Wu et al. 1998). Still, the association between soy
digestibility and is found in nutrition bars, cereals, intake and breast cancer risk remains inconclusive.
and yogurts. However, other studies have demonstrated positive
Isolates are the most refined soy protein effects of soy protein supplementation on
product containing the greatest concentration of maintaining bone mineral content (Ho et al., 2003)
protein, but unlike flour and concentrates, contain and reducing the severity of menopausal symptoms
no dietary fiber. Isolates originated around the (Murkies et al., 1995).
1950s in The United States. They are very High Protein Diets
digestible and easily introduced into foods such as
sports drinks and health beverages as well as infant Increased protein intakes and supplementation
formulas. have generally been focused on athletic
populations. However, over the past few years
Nutritional Benefits high protein diets have become a method used by
For centuries, soy has been part of a human diet. the general population to enhance weight
Epidemiologists were most likely the first to reduction. The lowcarbohydrate, high protein,
recognize soy’s benefits to overall health when high fat diet promoted by Atkins may be the most
considering populations with a high intake of soy. popular diet used today for weight loss in the
These populations shared lower incidences in United States (Johnston et al., 2004). The basis
certain cancers, decreased cardiac conditions, and behind this diet is that protein is associated with
improvements in menopausal symptoms and feelings of satiety and voluntary reductions in
osteoporosis in women (Hasler, 2002). Based upon caloric consumption (Araya et al., 2000;
a multitude of studies examining the health benefits Eisenstein et al., 2002). A recent study has shown
of soy protein the American Heart Association that the Atkins diet can produce greater weight
issued a statement that recommended soy protein reduction at 3 and 6 months than a low-fat, high
foods in a diet low in saturated fat and cholesterol carbohydrate diet based upon U.S. dietary
to promote heart health (Erdman, 2000). The health guidelines (Foster et al., 2003). However,
benefits associated with soy protein are related to potential health concerns have arisen concerning
the physiologically active components that are part the safety of high protein diets. In 2001, the
of soy, such as protease inhibitors, phytosterols, American Heart Association published a statement
saponins, and isoflavones (Potter, 2000). These on dietary protein and weight reduction and
components have been noted to demonstrate suggested that individuals following such a diet
lipidlowering effects, increase LDL-cholesterol may be at potential risk for metabolic, cardiac,
oxidation, and have beneficial effects on lowering renal, bone and liver diseases (St.
blood pressure. Jeor et al., 2001).

Isoflavones Protein Intake and Metabolic Disease Risk One

Of the many active components in soy products, of the major concerns for individuals on high
isoflavones have been given considerably more protein, low carbohydrate diets is the potential for
attention than others. Isoflavones are thought to be the development of metabolic ketosis. As
beneficial for cardiovascular health, possibly by carbohydrate stores are reduced the body relies
lowering LDL concentrations (Crouse et al., 1999) more upon fat as its primary energy source. The
increasing LDL oxidation (Tikkanen et al., 1998) greater amount of free fatty acids that are utilized
and improving vessel elasticity (Nestel et al., by the liver for energy will result in a greater
1999). However, these studies have not met without production and release of ketone bodies in the
conflicting results and further research is still circulation. This will increase the risk for
warranted concerning the benefits of isoflavones. metabolic acidosis and can potentially lead to a
coma and death. A recent multisite clinical study
Soy Benefits for Women (Foster et al., 2003) examined the effects of low-
An additional focus of studies investigating soy carbohydrate, high protein diets and reported
supplementation has been on women’s health significant elevation in ketone bodies during the
issues. It has been hypothesized that considering first three months of the study. However, as the
125 Hoffman and Falvo

study duration continued the percentage of approximately half of the normal RDA level for
subjects with positive urinary ketone daily protein intake (0.8 g⋅kg1⋅day-1). Lowering
concentrations became reduced, and by six protein intake is thought to reduce the progression
months urinary ketones were not present in any of of renal disease by decreasing hyperfiltration
the subjects. (Brenner et al., 1996).

Dietary Protein and Cardiovascular Disease Risk Dietary Protein and Bone
High protein diets have also been suggested to High protein diets are associated with an increase in
have negative effects on blood lipid profiles and calcium excretion. This is apparently due to a
blood pressure, causing an increase risk for consumption of animal protein, which is higher in
cardiovascular disease. This is primarily due to sulfur-based amino acids than vegetable proteins
the higher fat intakes associated with these diets. (Remer and Manz, 1994; Barzel and Massey,
However, this has not been proven in any 1998). Sulfur-based amino acids are thought to be
scientifically controlled studies. Hu et al., (1999) the primary cause of calciuria (calcium loss). The
have reported an inverse relationship between mechanism behind this is likely related to the
dietary protein (animal and vegetable) and risk of increase in acid secretion due to the elevated
cardiovascular disease in women, and Jenkins and protein consumption. If the kidneys are unable to
colleagues (2001) reported a decrease in lipid buffer the high endogenous acid levels, other
profiles in individuals consuming a high protein physiological systems will need to compensate,
diet. Furthermore, protein intake has been shown such as bone. Bone acts as a reservoir of alkali, and
to often have a negative relationship with blood as a result calcium is liberated from bone to buffer
pressure (Obarzanek et al., 1996). Thus, the high acidic levels and restore acid-base balance.
concern for elevated risk for cardiovascular The calcium released by bone is accomplished
disease from high protein diets appears to be through osteoclast-mediated bone resorption
without merit. Likely, the reduced body weight (Arnett and Spowage, 1996). Bone resorption (loss
associated with this type of diet is facilitating or removal of bone) will cause a decline in bone
these changes. mineral content and bone mass (Barzel, 1976),
In strength/power athletes who consume high increasing the risk for bone fracture and
protein diets, a major concern was the amount of osteoporosis.
food being consumed that was high in saturated The effect of the type of protein consumed
fats. However, through better awareness and on bone resorption has been examined in a
nutritional education many of these athletes are number of studies. Sellmeyer and colleagues
able to obtain their protein from sources that (2001) examined the effects of various animal-to-
minimizes the amount of fat consumed. For vegetable protein ratio intakes in elderly women
instance, removing the skin from chicken breast, (> 65 y). They showed that the women consuming
consuming fish and lean beef, and egg whites. In the highest animal to vegetable protein ratio had
addition, many protein supplements are available nearly a 4-fold greater risk of hip fractures
that contain little to no fat. It should be compared with women consuming a lower animal
acknowledged though that if elevated protein does to vegetable protein ratio. Interestingly, they did
come primarily from meats, dairy products and not report any significant association between the
eggs, without regard to fat intake, there likely animal to vegetable protein ratio and bone mineral
would be an increase in the consumption of density. Similar results were shown by Feskanich
saturated fat and cholesterol. et al (1996), but in a younger female population
(age range = 35 – 59 mean 46). In contrast, other
Dietary Protein and Renal Function studies examining older female populations have
The major concern associated with renal function shown that elevated animal protein will increase
was the role that the kidneys have in nitrogen bone mineral density, while increases in vegetable
excretion and the potential for a high protein diet to protein will have a lowering effect on bone
over-stress the kidneys. In healthy individuals mineral density (Munger et al., 1999; Promislow
there does not appear to be any adverse effects of a et al., 2002). Munger and colleagues (1999) also
high protein diet. In a study on bodybuilders reported a 69% lower risk of hip fracture as
consuming a high protein (2.8 g⋅kg-1) diet no animal protein intake increased in a large (32,000)
negative changes were seen in any kidney function postmenopausal population. Other large
tests (Poortsman and Dellalieux, 2000). However, epidemiological studies have also confirmed
in individuals with existing kidney disease it is elevated bone density following high protein diets
recommended that they limit their protein intake to in both elderly men and women (Dawson-Hughes
 Protein ratings 126

et al., 2002; Hannan et al., 2000). Hannon and Pork .73

colleagues (2000) demonstrated that animal Wheat (whole) .69
protein intake in an older population, several times White Rice .68
greater than the RDA requirement, results in a Barley .68
bone density accruement and significant decrease Tuna .65
in fracture risk. Dawson-Hughes et al (2002), not Chicken .65
only showed that animal protein will not increase Corn .61
urinary calcium excretion, but was also associated Beef .59
with higher levels of IGF-I and lower Milk .55
concentrations of the bone resorption marker N-
Cheddar .46
telopeptide.
Soy .40
These conflicting results have contributed to
Peanuts .40
the confusion regarding protein intake and bone.
It is likely that other factors play an important role Millet .31
in further understanding the influence that dietary Almonds .23
proteins have on bone loss or gain. For instance, Potato .23
the intake of calcium may have an essential Adapted from Massey, 2003.
function in maintaining bone. A higher calcium
intake results in more absorbed calcium and may Protein Intake and Liver Disease Risk
offset the losses induced by dietary protein and The American Heart Association has suggested that
reduce the adverse effect of the endogenous high protein diets may have detrimental effects on
acidosis on bone resorption (Dawson-Hughes, liver function (St. Jeor et al., 2001). This is
2003). Furthermore, it is commonly assumed that primarily the result of a concern that the liver will
animal proteins have a higher content of sulfur- be stressed through metabolizing the greater protein
containing amino acids per g of protein. However, intakes. However, there is no scientific evidence to
examination of Table 4 shows that this may not support this contention. Jorda and colleagues
entirely correct. If protein came from wheat (1988) did show that high protein intakes in rats
sources it would have a mEq of 0.69 per g of produce morphological changes in liver
protein, while protein from milk contains 0.55 mitochondria. However, they also suggested that
mEq per g of protein. Thus, some plant proteins these changes were not pathological, but
may have a greater potential to produce more mEq represented a positive hepatocyte adaptation to a
of sulfuric acid per g of protein than some animal metabolic stress.
proteins (Massey, 2003). Finally, bone resorption Protein is important for the liver not only in
may be related to the presence or absence of a promoting tissue repair, but to provide lipotropic
vitamin D receptor allele. In subjects that had this agents such as methionine and choline for the
specific allele a significant elevation in bone conversion of fats to lipoprotein for removal form
resorption markers were present in the urine the liver (Navder and Leiber, 2003a). The
following 4-weeks of protein supplementation, importance of high protein diets has also been
while in subjects without this specific allele had acknowledged for individuals with liver disease and
no increase in N-telopeptide (Harrington et al., who are alcoholics. High protein diets may offset
2004). The effect of protein on bone health is still the elevated protein catabolism seen with liver
unclear, but it does appear to be prudent to disease (Navder and Leiber, 2003b), while a high
monitor the amount of animal protein in the diet protein diet has been shown to improve hepatic
for susceptible individuals. This may be more function in individuals suffering from alcoholic
pronounced in individuals that may have a genetic liver disease (Mendellhall et al., 1993).
endowment for this. However, if animal protein
consumption is modified by other nutrients (e.g. Comparisons between Different Protein
calcium) the effects on bone health may be Sources on Human Performance
lessened.
Earlier discussions on protein supplementation
Table 4. Potential acid as sulfate from and athletic performance have shown positive
sulfurcontaining amino acids. effects from proteins of various sources. However,
Food mEq per g of protein only limited research is available on comparisons
Oatmeal .82 between various protein sources and changes in
Egg .80 human performance. Recently, there have been a
Walnuts .74 number of comparisons between bovine colostrum
127 Hoffman and Falvo

and whey protein. The primary reason for this appearance of amino acids is fast, high and
comparison is the use by these investigators of transient. In contrast, casein is absorbed more
whey protein as the placebo group in many of the slowly producing a much less dramatic rise in
studies examining bovine colostrum (Antonio et plasma amino acid concentrations. Whey protein
al., 2001; Brinkworth et al., 2004; Brinkworth and ingestion stimulated protein synthesis by 68%,
Buckley, 2004; Coombes et al., 2002; Hofman et while casein ingestion stimulated protein synthesis
al., 2002). The reason being that whey protein is by 31%. When the investigators compared
similar in taste and texture as bovine colostrum postprandial leucine balance after 7-hours post
protein. ingestion, casein consumption resulted in a
Studies performed in non-elite athletes have significantly higher leucine balance, whereas no
been inconclusive concerning the benefits of change from baseline was seen 7-hours following
bovine colostrum compared to whey protein. whey consumption. These results suggest that whey
Several studies have demonstrated greater gains in protein stimulates a rapid synthesis of protein, but a
lean body mass in individuals supplementing with large part of this protein is oxidized (used as fuel),
bovine colostrum than whey, but no changes in while casein may result in a greater protein
endurance or strength performance (Antonio et al., accretion over a longer duration of time. A
2001; Brinkworth et al., 2004). However, when subsequent study showed that repeated ingestions
performance was measured following prolonged of whey protein (an equal amount of protein but
exercise (time to complete 2.8 kJ⋅kg-1 of work consumed over a prolonged period of time [4
following a 2-hour ride) supplement dosages of 20 hours] compared to a single ingestion) produced a
g⋅day-1 and 60 g⋅day-1 were shown to significantly greater net leucine oxidation than either a single
improve time trial performance in competitive meal of casein or whey (Dangin et al., 2001).
cyclists (Coombes et al., 2002). These results may Interestingly, both casein and whey are complete
be related to an improved buffering capacity proteins but their amino acid composition is
following colostrum supplementation. different. Glutamine and leucine have important
Brinkworth and colleagues (2002) reported that roles in muscle protein metabolism, yet casein
although no performance changes were seen in contains 11.6 and 8.9 g of these amino acids,
rowing performance, the elite rowers that were respectively while whey contains 21.9 and 11.1 g of
studied did demonstrate an improved buffering these amino acids, respectively. Thus, the digestion
capacity following 9-weeks of supplementation rate of the protein may be more important than the
with amino acid composition of the protein.
In a study examining the effects of casein and
60 g⋅day-1 of bovine colostrum when compared to
whey on body composition and strength measures,
supplementing with whey protein. The improved
12 weeks of supplementation on overweight police
buffering capacity subsequent to colostrum
officers showed significantly greater strength and
supplementation may have also influenced the
lean tissue accruement in the subjects ingesting
results reported by Hofman et al., (2002). In that
casein compared to whey (Demling and DeSanti,
study elite field hockey players supplemented
2000). Protein supplementation provided a relative
with either 60 g⋅day-1 of either colostrum or whey
protein consumption of 1.5 g⋅kg⋅day-1. Subjects
protein for 8-weeks. A significantly greater
supplemented twice per day approximately 8–10
improvement was seen in repeated sprint
hours apart.
performance in the group supplementing with
Only one study known has
colostrum compared to the group supplementing
compared colostrum, whey and casein
with whey protein. However, a recent study has
supplementation (Fry et al., 2003). Following 12-
suggested that the improved buffering system seen weeks of supplementation the authors reported no
following colostrum supplementation is not significant differences in lean body mass, strength
related to an improved plasma buffering system, or power performances between the groups.
and that any improved buffering capacity occurs However, the results of this study should be
within the tissue examined with care. The subjects were comprised
(Brinkworth et al., 2004). of both males and females who were resistance
In a comparison between casein and whey training for recreational purposes. In addition, the
protein supplementation, Boirie and colleagues subject number for each group ranged from 4–6
(1997) showed that a 30-g feeding of casein versus subjects per group. With a heterogeneous subject
whey had significantly different effects on population and a low subject number, the statistical
postprandial protein gain. They showed that power of this study was quite low. However, the
following whey protein ingestion the plasma authors did analyze effect sizes to account for the
 Protein ratings 128

low statistical power. This analysis though did not Barzel, U.S. and Massey, L.K. (1998) Excess dietary
change any of the observations. Clearly, further protein can adversely affect bone. Journal of
research is needed in comparisons of various types Nutrition 128, 1051-1053.
of protein on performance improvements. Boirie, Y., Dangin, M., Gachon, P., Vasson, M.P.,
However, it is likely that a combination of different Maubois, J.L. and Beaufrere, B. (1997) Slow and
proteins from various sources may provide optimal fast dietary proteins differently modulate
benefits for performance. postprandial protein accretion. Proclamations of
National Academy of Sciences 94, 14930-14935.
Brenner, B.M., Lawler, E.V. and Mackenzie, H.S.
CONCLUSIONS (1996) The hyperfiltration theory: a paradigm
shift in nephrology. Kidney International 49,
It does appear that protein from animal sources is 1774-1777.
an important source of protein for humans from Brinkworth, G.D. and Buckley J.D. (2004) Bovine
infancy until mature adulthood. However, the colostrums supplementation does not affect
potential health concerns associated with a diet of plasma buffer capacity or haemoglobin content in
protein consumed primarily from animal sources elite female rowers. European Journal of Applied
Physiology 91, 353-356.
should be acknowledged. With a proper
Brinkworth, G., Buckley, J., Bourdon, P., Bulbin, J. and
combination of sources, vegetable proteins may David, A. (2002) Oral bovine colostrum
provide similar benefits as protein from animal supplementation enhances buffer capacity, but not
sources. Maintenance of lean body mass though rowing performance in elite female rowers.
may become a concern. However, interesting data International Journal of Sports Nutrition and
does exist concerning health benefits associated Exercise Metabolism 12, 349-363.
with soy protein consumption. Brinkworth, G.D., Buckley, J.D., Slavotinek, J.P. and
In athletes supplementing their diets with Kurmis, A.P. (2004) Effect of bovine colosturm
additional protein, casein has been shown to supplementation on the composition of resistance
provide the greatest benefit for increases in protein trained and untrained limbs in healthy young men.
European Journal of Applied Physiology 91,
synthesis for a prolonged duration. However, whey
5360.
protein has a greater initial benefit for protein
Buckley J.D., Brinkworth, G.D. and Abbott, M.J. (2004)
synthesis. These differences are related to their Effect of bovine colostrums on anaerobic exercise
rates of absorption. It is likely a combination of the performance and plasma insulin-like growth
two could be beneficial, or smaller but more factor I. Journal of Sport Sciences 21, 577-588.
frequent ingestion of whey protein could prove to Campbell, W.W., Barton Jr., M.L., Cyr-Campbell, D.,
be of more value. Considering the paucity of Davey, S.L., Beard, J.L., Parise, G. and Evans,
research examining various sources of protein in W.J. (1999) Effects of an omnivorous diet
sport supplementation studies, further research compared with a lactoovovegetarian diet on
appears warranted on examining the benefits of resistance-training-induced changes in body
these various protein sources. composition and skeletal muscle in older men.
American Journal of Clinical Nutrition 70,
10321039.
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AUTHORS BIOGRAPHY
Jay R. HOFFMAN
Employment
Department of Health and Exercise Science. The
College of New Jersey
Degree
PhD
Research interests
Endocrinology of sports performance and nutritional
supplementation. Email: [email protected]
Michael J. FALVO
Employment
Department of Health and Exercise Science. The
College of New
Jersey Degrees B.S.

KEY POINTS

• Higher protein needs are seen in athletic

populations.
• Animal proteins is an important source of
protein, however potential health concerns do
exist from a diet of protein consumed from
primarily animal sources.
• With a proper combination of
sources, vegetable proteins may provide
similar benefits as protein from animal sources.
• Casein protein supplementation may provide
the greatest benefit for increases in protein
synthesis for a prolonged duration.

 Jay R. Hoffman, Ph.D.

Department of Health and Exercise Science, The College
of New Jersey, PO Box 7718,Ewing, NJ 08628-0718,
USA