Research Digest

Exclusive Sneak Peek

Issue 12, Vol 1 of 2

October 2015

Click here to purchase ERD

Table of Contents
Paying attention to omega-3s for ADHD
With more and more people being diagnosed with ADHD, theres a continuing hunt for
helpful treatments. Researchers tested an omega-3 supplement on young males, and
also explored a potential dopamine-related mechanism.

Ask the Researcher: Trevor Kashey, Ph.D.

From jelly to muscle: collagen and body composition
Collagen has long been equated to junk protein, at least if youre looking to gain muscle.
Could it be underrated for this purpose? A trial of older men tested collagen protein to
see if it could boost muscle gain and fat loss.

Throwdown: plant vs animal protein for metabolic syndrome

The DASH diet is frequently tested in clinical trials, and often performs well. But the diets
formulation includes strong limitations on red meat, which may be based on outdated
evidence. This study compared animal-protein rich diets with a typical DASH diet.

Can omega-3s modulate the mind-muscle connection?

While strength gains are usually associated with protein and muscle-related ergogenics,
the nervous system isnt targeted as often. This study explored a different type of omega-3 source (seal oil) for neuromuscular exercise effects.

Throwdown: plant vs
animal protein for
metabolic syndrome

Type and amount of dietary protein in

the treatment of metabolic syndrome: a
randomized controlled trial

Introduction
Metabolic syndrome is a cluster of risk factors that
greatly increases the risk of dying from any cause (1.5fold) and especially cardiovascular disease (CVD)
specific causes (2.4-fold). This condition is diagnosed
as either having or being on medications to treat at least
three of the five following criteria:
Abdominal obesity (waist circumference greater
than 40 inches (men) or 35 inches (women)),
Elevated fasting blood glucose (more than 110 mg/
dL),
Elevated fasting triglycerides (more than 150 mg/
dL),
Low HDL-c (less than 40 (men) or 50 (women)
mg/dL), and

In the OmniHeart (Optimal Macronutrient Intake Trial

for Heart Health) trial, two variations of the DASH
dietary pattern were compared with DASH. One
variation replaced 10% of total daily energy from carbohydrate with protein, and the other replaced the same
amount of carbohydrate with unsaturated fat. Both
variations led to greater reductions of estimated CVD
risk than the standard DASH diet. Notably, all three
tested diets had a roughly even split between animaland plant-based protein.
This study sought to expand upon the findings of the
OmniHeart trial by comparing the effects of three variations of the DASH diet, which differed in protein type
(plant vs. animal) and amount (18% vs. 27%), on metabolic syndrome criteria.

Hypertension (systolic blood pressure higher than

130 mmHg and/or diastolic blood pressure higher

Metabolic syndrome is a cluster of risk factors that

than 85 mmHg).

greatly increases the risk of cardiovascular diseases,

the treatment of which includes diet and exercise to

Reducing these risk factors for CVD is the primary

facilitate weight loss. The DASH diet is considered

goal of managing metabolic syndrome, which is often

a prudent dietary pattern to address these risk fac-

done through lifestyle modification. Notably, changes

tors, but other research has shown variations of the

to diet and exercise that facilitate a 5-10% weight loss

diet to be more efficient. The study under review was

can address and significantly improve each risk fac-

designed to determine how protein type (plant vs.

tor. While a variety of dietary approaches can result in

animal) and amount (18% vs. 27%) affected metabol-

weight loss in overweight and obese adults, as explored

ic syndrome criteria.

in ERD Issue #6 (April, 2015), some dietary approaches may benefit people with metabolic syndrome more
than other approaches.
One currently accepted dietary pattern to reduce
CVD risk factors is the Dietary Approaches to Stop
Hypertension (DASH) diet, which is high in vegetables,
fruit, low-fat dairy products, whole grains, poultry, fish,
and nuts. The diet is low in sweets, sugar-sweetened
beverages, and red meats. The DASH diet is designed
to be low in saturated fat, total fat, and cholesterol, and
rich in fiber, potassium, magnesium, and calcium.

Who and what was studied?

This six-month, randomized, parallel-arm, controlled-feeding study recruited 62 sedentary overweight
and obese adults with metabolic syndrome. The participants were free of established cardiovascular diseases,
diabetes, or liver, kidney, and autoimmune diseases.
Two participants on glucose-lowering drugs and seven
participants on lipid-lowering medications were asked
to discontinue their use for the duration of the study,
but the eight participants taking medication for high
blood pressure were allowed to continue.

The entire study consisted of four phases:

WM, and WL phases, but only one meal per day was
consumed under the supervision of research personnel.

1. A two-week healthy American diet (HAD) run-

The remainder of the food was packed for taking home.

in period to establish a baseline for comparison

This means that even though all experimental diets were

during the subsequent phases and establish

tightly controlled, there was no guarantee that the par-

weight-maintenance caloric intake for each

ticipants would eat all of the food provided to them, and

participant.

only the food provided (i.e. no outside food or drink).

2. A five-week weight maintenance (WM) phase following one of three experimental diets.
3. A six-week weight loss (WL) phase consuming

The experimental diets were a modified-DASH

(M-DASH) diet rich in plant protein (18% of the calo-

the same experimental diet as in WM but with a

ries from protein, two-thirds from plants), an M-DASH

minimum 500 kcal per day deficit through dietary

diet rich in animal protein (BOLD, which stands

restriction and increased physical activity; and

for Beef in an Optimal Lean Diet; 18% protein, two-

4. A 12-week free living (FL) phase where participants were asked to continue their assigned

thirds from animals), and a higher-protein BOLD diet

(BOLD+; 27% protein, two-thirds from animals).

hypocaloric diets and physical activity, but without the provision of food and drinks. To prepare

These diets were matched for total fat (as seen in Figure

for this phase, each participant met with a dieti-

1), saturated fat, monounsaturated fat, polyunsaturat-

tian three times during the WL phase. They were

ed fat, cholesterol, sodium, potassium, calcium, and

educated on the unique features of their assigned

magnesium so as to help isolate the effects of differ-

diet and given practical advice, including suggest-

ent amounts and sources of protein. However, the

ed menus and recipes.

M-DASH diet was significantly higher in fiber (55 vs.

38 grams) than the other two diets because of the reli-

All food and drink were prepared by a metabolic kitch-

ance on plant-based protein sources. Examples of each

en and provided to the participants during the HAD,

study diets are shown in Table 1.

Figure 1: Macronutrient breakdown of the four diets

differences in any outcome between the three dietary

Overweight and obese adults with metabolic syndrome

groups. Most of the significant health improvements

were randomized to follow a modified DASH diet rich

occurred only after the WL phase. Accordingly, there

in either plant protein (M-DASH) or animal protein

was no change in the prevalence of metabolic syndrome

(BOLD), or a higher protein BOLD diet (BOLD+) for

among the participants from baseline through WM, but

a five-week weight maintenance phase and a six-week

prevalence dropped substantially to 50-60% after the

weight loss phase, with all food and drink prepared

WL phase and was maintained through the FL phase. In

and provided by the research staff. Afterward, the par-

other words, roughly half of the participants were no

ticipants were asked to continue their respective diets

longer classified as suffering from metabolic syndrome

for 12 weeks under free-living conditions.

after the WL phase. A summary of the study findings is

shown in Figure 2.

What were the findings?

The resolution of metabolic syndrome was the result of

Over the entire six-month intervention, there were no

significant improvements in every criterion except for

blood glucose levels. On average, after the WL phase

Table 1: Examples of the four study diets: Menus for the test diets

Breakfast

Lunch

Dinner

Snack

HAD
Pancakes with butter
and light syrup
Peaches, canned
in juice
Cottage cheese (1%)
Apple Juice

M-DASH
Pancakes with butter
and light syrup
Blueberries
Skim Milk
Orange Juice

Spinach/baby greens
salad with cherry
Turkey, provolone
tomatoes, mandarin,
cheese, and lettuce
oranges, grilled chicken
sandwich on white
breast, and dressing
bread with mayonnaise
Edamame beans
Granola bar
Whole-wheat dinner
roll with butter
Pistachios
Szechuan stir-fry entr Ratatouille (eggplant/
with pork and white rice
peppers) with pasta
White dinner roll
Spinach salad
with butter
with carrots, cherry
Romaine lettuce
tomatoes, red bell
salad with carrots
pepper, chickpeas,
and italian dressing
and dressing

Plain bagel with

cream cheese

Light yogurt
High-fiber cereal
Almonds

BOLD
Bran flakes with
raisins and skim milk
Whole-wheat minibagel and margarine
Orange Juice
Banana
Barbeque beef
sandwich on wholewheat bun
Spinach salad with
cherry tomatoes
and dressing
Thin pretzels
Pear

BOLD+
Bran Flakes with
raisins and skim milk
Cottage cheese (1%)
Orange Juice

Beef chili with

shredded cheddar
cheese (low fat) and
while-wheat crackers
Peaches, canned
in juice

Pot roast with mashed

Spinach and beef
potatoes and gracy
skillet with ribeye steak
White dinner roll
Brown rice
with margarine
Mixed baby greens
Broccoli and
salad with carrots,
edamame beans
cherry tomatoes,
Romaine salad with
and dressing
cherry tomatoes
and dressing
Hummus with
Light yogurt
whole wheat pita
Orange
and baby carrots
Almonds
Trail mix

and compared to the WM phase, there was a three

to four centimeter (about 3%) reduction in waist circumference, a 13-30% reduction in triglycerides, a one
to four mmHg reduction in systolic blood pressure,

Figure 2: Effects of all the diets on

metabolic syndrome factors

a one to three mmHg reduction in diastolic blood

pressure, and a 4-9% increase in HDL-c. Additionally,
total and LDL-cholesterol were reduced from baseline
during both the WM and WL phases, possibly due to
the reduced saturated fat intake among all diets, but
returned to baseline values during the FL phase. The
WL phase also led to significant improvements in CRP
(a marker for inflammation), endothelial function, and
vascular stiffness.
The only difference between the WM and WL phases
was a 500 kcal reduction in the food provided to the
participants and a significant increase in the number of
daily pedometer-measured steps taken, from 6,300 to
10,500. Together, this resulted in a significant 5% weight
loss across all groups, with roughly 80% coming from
fat mass. Since metabolic syndrome resolved only after
the WL phase, these findings suggest that weight loss
was the primary driver of health improvement.
Compliance during the WM and WL phases was
determined through daily questionnaires. Participants
were classified as noncompliant on any day that they
consumed a non-study food or beverage or did not
consume a study food or beverage. Accordingly, dietary
compliance ranged from 70-90% throughout the WM
and WL phases, but appeared to be higher in the
M-DASH (82-90%) group than the BOLD (70-75%) or
BOLD+ (77-80%) groups.

Regardless of diet, weight loss appeared to be the

primary driver of improved health among the participants. In all diet groups, the number of individuals
with metabolic syndrome was reduced by 40-50%
after they lost about 5% of their bodyweight during
the weight-loss phase.

Note: ranges are based on average changes across all the diets.
None of the diets effects were statistically different from one another.

What does the study really

tell us?

teins. This finding is consistent with numerous other

The researchers conducting this study sought to explore

ence between lean red and white meats and suggests

how protein type and amount affects the health of

that red meat can be safely included in an otherwise

people with metabolic syndrome through three dif-

healthy diet.

compared to a diet supplying mainly plant-based prointervention trials (1, 2, 3, 4, 5, 6) showing no differ-

ferent phases of energy balance: weight maintenance,

weight loss, and free living. The results indicate that nei-

The current study had a strong design, with ample time

ther protein type or amount have a significant impact

in each phase to allow for changes in CVD risk markers

on health at any stage, and that clinically significant

to occur. However, the trial was designed to be statisti-

weight loss (5% in this study) is the primary driver for

cally powered only to detect changes over time in each

reductions in abdominal obesity, triglycerides, blood

diet group, meaning that any between-group differenc-

pressure, and inflammation (CRP).

es may not have manifested due to a lack of statistical

power. This may be most apparent when acknowledg-

Current DASH diet recommendations include limit-

ing the lack of difference between the normal protein

ing the consumption of red meat. Many other dietary

and higher protein diet in terms of changes in body

patterns that are considered healthy, such as the

composition.

Mediterranean diet, tend to have relatively less animal

protein, with relatively more protein from whole grains

After all, it is recognized that higher protein diets, such

and legumes. The current study used unprocessed

as those used in this study (27%), lead to greater fat

lean beef (select grade top round, ribeye, chuck shoul-

loss and retention of muscle mass than normal protein

der, and 95% ground beef) and found that consuming

diets. Additionally, higher protein diets facilitate weight

nearly seven ounces (200 grams) per day had no det-

loss through increased satiety. Unfortunately, the

rimental (or beneficial) impact on CVD risk factors

controlled-feeding design of this study required partic-

The current study used

unprocessed lean beef and found that
consuming nearly seven ounces (200
grams) per day had no detrimental (or
beneficial) impact on CVD risk factors
compared to a diet supplying mainly
plant-based proteins.

ipants to eat all food provided to them, eliminating the

address an increasing rate of hypertension among

satiety advantage. While not statistically significant, it

the general public. One of the unique features of the

is noteworthy that only the BOLD+ diet continued to

DASH diet is that it focuses on dietary patterns rath-

demonstrate weight and fat loss alongside increases in

er than single nutrients, based on past observational

lean body mass during the free-living phase, when the

evidence combined with knowledge of select vitamins

benefits of a higher protein diet could be realized.

and minerals. Accordingly, the DASH diet was built

on a foundation of natural foods such including fruit,

Alternatively, the high and low protein diet groups were

vegetables, whole grains, nuts, legumes, and seeds that

consuming 2.5 and 1.7 grams of protein per kilogram

are good sources of potassium, magnesium, and dietary

of lean-body mass, respectively, and it has been sug-

fiber. Additionally, it incorporates low-fat dairy prod-

gested that optimal intake for resistance-trained obese

ucts, fish, chicken, and lean meats to reduce total and

adults is around 1.9 grams per kilogram. The current

saturated fat consumption and increase protein and

study did not utilize resistance training, so an optimal

calcium intake.

amount of protein would likely be lower and possibly

around that of the lower protein diets. Accordingly, the

Because nutrition is not static, this successful dietary

lower protein diet may have been sufficient in protein

pattern has undergone small changes in the last two

to account for the insignificant difference in weight loss

decades, such as limited red meat in favor of fish and

or lean mass kept from a higher protein intake.

poultry. This change was based on observational evidence suggesting a link between red meat and CVD.

Lastly, the recruitment goals of the study were not met,

As follow-up research has shown, this recommenda-

which may have limited the statistical power to detect

tion may have been premature. Associations are not

significant changes over time within each dietary group.

cause-and-effect relationships and there are countless

However, there were no trends that presumably may

potential explanations for why an association exists.

have reached significance with additional participants.

Against that background, it is all the more important to

highlight that the study under review just like sever-

Clinically meaningful weight loss (about 5%)

appears to benefit health regardless of protein type
or amount. Although this study showed no benefit to
higher protein intake, a potential lack of statistical
power to detect between-group changes, as has been
observed in previous studies evaluating the effect
of protein on body composition, suggests the finding should be accepted with caution. In agreement
with other intervention trials, unprocessed lean red
meat may be safely included as part of an otherwise
healthy diet.

al previous studies found no evidence that lean red

meat poses a CVD risk, at least not one that is detectable by the measurement of common CVD risk markers.
This is certainly not the first time policy makers have
based recommendations on associations, only to be
unsupported by subsequent intervention trials. In
ERD Issue #7 (May, 2015), we discussed the DIABEGG
study that sought to clarify whether eggs could be
safely included in the diet of people with type 2 diabetes. This research was needed because observational
evidence showed that people with type 2 diabetes who
ate eggs more than once per day were 69% more likely

The big picture

to develop CVD comorbidity than those who ate eggs

The DASH diet was developed in the mid-1990s to

for each four-per-week increase in egg intake, the risk

less than once per week. Other research showed that

of CVD increased by 40%. Not only did the DIABEGG

What is the difference between red meat and white

study show that eggs had no impact on blood lipids

meat, other than color?

or glycemic control, it showed that eggs increased

Red meat is a general term referring to meat from

post-breakfast satiety and resulted in a more enjoyable

land mammals, including cattle, lamb, goat, and sheep,

dietary experience by the participants.

whereas white meat is a general term referring to meat

from poultry, lean game like rabbit, and non-fatty

Observational evidence is important for noticing potential links between diet and health, but it
serves only as a starting point that requires further
and more rigorous testing. It is not uncommon for
dietary recommendations to incorporate observational evidence that is later shown to be incorrect

fish, such as cod and pollock. The primary difference

between these types of meat is their primary muscle
fiber type: red meat is slow-twitch and white meat is
fast-twitch. It should be noted that both types of fibers
exist in the meat, and these terms refer to the dominant
fiber type.

by experimental trials. The study at hand is a great

example, showing that the observational link
between red meat and CVD may be a bit misleading,
based previous trial evidence plus this study showing
a lack of difference in CVD risk markers between the
plant- and animal-based protein groups.

Frequently asked questions

Are there other dietary patterns with evidence for

improving metabolic syndrome?

Ultimately, any diet that results in fat loss will help with
metabolic syndrome. However, some dietary patterns
may better facilitate the necessary caloric deficit. For
instance, a paleolithic diet excluding cereal grains, dairy,
and legumes in favor of lean meats, fruit, fibrous and
starchy vegetables, and nuts has been shown to result
in more favorable health outcomes than a healthy reference diet, as discussed in ERD Issue #6 (April, 2015).
The paleo diet referenced above is unique in that it promotes the consumption of lean unprocessed meats. This
is in contrast to observational evidence that suggests
protective dietary patterns are low in red and processed
meats, providing yet more evidence that the exclusion
of lean red meat is not what makes these other dietary
patterns beneficial.

Ultimately,
any diet that
results in fat
loss will help
with metabolic
syndrome.
However,
some dietary
patterns may
better facilitate
the necessary
caloric deficit.

Slow-twitch fibers are designed to contract continu-

considered a prudent dietary pattern to address these

ously for long periods of time and thus rely heavily on

risk factors, but some components of it are based largely

oxygen for energy production via the aerobic path-

on observational evidence, such as the suggestion to

way. The protein myoglobin stores oxygen in muscle

limit red meat.

cells and is richly pigmented, so the more myoglobin

there is in the cells, the redder, or darker, the meat. By

The current study tested the validity of this recommen-

contrast, fast-twitch muscles are designed to contract

dation and showed that consuming up to seven ounces

forcefully and rapidly for very short periods of time and

(200 grams) of unprocessed lean red meat per day as

rely more on glucose than oxygen to function properly.

a primary protein source has no differential impact on

Therefore, they dont store a lot of myoglobin, instead

CVD risk factors and metabolic syndrome than a diet

favoring glycogen, and thus appear more glossy white.

where the majority of protein is obtained from plants.

Overall, the results suggest that clinically meaningful

From a nutritional perspective, the two types of meat

weight loss (about 5%) will benefit health regardless

are very similar. White meat is much leaner on average,

of protein type or amount. However, protein-specific

but there are also many types of lean red meat such as

benefits on other health outcomes like body composi-

bison and beef steak cut from the round of the cow. Red

tion require further research, as the current study may

meat also tends to be higher in vitamin B12, zinc, and

not have been adequately powered to detect significant

iron, while white meat contains more niacin and panto-

differences.

thenic acid.

What should I know?

The DASH diet has been studied in countless trials, but

this is the first to show that its low-red-meat stipula-

Metabolic syndrome is a cluster of cardiovascular dis-

tion may be misguided. Head over the ERD Facebook

ease risk factors, the treatment of which includes diet

forum to talk more about this study.

and exercise to facilitate weight loss. The DASH diet is

Overall, the results suggest that

clinically meaningful weight loss (about
5%) will benefit health regardless of
protein type or amount.