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BarB's avatar

Hi, I love your unique take on things, thanks for being out there.

P. S. About all this protein obsession? Grams of total "protein" are confusing as only TOTAL proteins (those that contain all essential amino acids) are immediately useful. Extra unused amino acids have to be eliminated via the kidneys, causing extra renal burden. As usual, human physiology is more complex than dietary hucksters would lead you to believe 🤷‍♀️

Zeichgeist's avatar

hey. two comments in a row. i'll stop for a bit now ;) i think you might want to research the science articles a bit before you post them to wit. here's openevidence the best medical ai on protein for elderly folks: For a healthy, active 71-year-old woman, the recommendation is **higher protein intake** — at least **1.0 to 1.2 g/kg body weight per day**, which is above the general adult RDA of 0.8 g/kg/day.[1][2][3]

Multiple expert groups support this higher target for older adults:

- **ESPEN** recommends at least 1.0–1.2 g/kg/day for healthy older people, with even higher intake (≥1.2 g/kg/day) for those who are physically active.[2][3]

- **PROT-AGE Study Group** similarly recommends 1.0–1.2 g/kg/day as a baseline for healthy older adults, and ≥1.2 g/kg/day for those who exercise regularly.[3]

- A 2025 NEJM review confirms broad agreement that older adults need **more protein than younger adults**, with at least 1.0 g/kg/day as the goal.[1]

The rationale is that older adults have a **higher anabolic threshold** — they need more protein per meal to stimulate muscle protein synthesis compared to younger adults.[4] Given that this patient walks four miles daily, she is actively stressing her musculoskeletal system, which further supports targeting the higher end of the range (1.2 g/kg/day).[3] Higher protein intake in older women has been associated with less appendicular lean mass loss and lower risk of mobility limitation.[5]

The one important caveat: protein restriction (below 0.8 g/kg/day) should be considered only in patients with **advanced CKD (stage 4–5, eGFR [1][3] Notably, evidence suggests that protein intake of 1.0–1.2 g/kg/day is not harmful to kidney function in older adults without advanced CKD.[6]

Would you like to explore whether adding resistance training to her walking routine would further optimize the benefits of higher protein intake for sarcopenia prevention?

### References

1. Malnutrition in Older Adults. Cruz-Jentoft AJ, Volkert D. The New England Journal of Medicine. 2025;392(22):2244-2255. doi:10.1056/NEJMra2412275.

2. Protein Intake and Exercise for Optimal Muscle Function With Aging: Recommendations From the ESPEN Expert Group. Deutz NE, Bauer JM, Barazzoni R, et al. Clinical Nutrition (Edinburgh, Scotland). 2014;33(6):929-36. doi:10.1016/j.clnu.2014.04.007.

3. Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group. Bauer J, Biolo G, Cederholm T, et al. Journal of the American Medical Directors Association. 2013;14(8):542-59. doi:10.1016/j.jamda.2013.05.021.

4. Malnutrition in Older Adults. Dent E, Wright ORL, Woo J, Hoogendijk EO. Lancet (London, England). 2023;401(10380):951-966. doi:10.1016/S0140-6736(22)02612-5.

5. Sex-and Race-Specific Associations of Protein Intake With Change in Muscle Mass and Physical Function in Older Adults: The Health, Aging, and Body Composition (Health ABC) Study. Elstgeest LEM, Schaap LA, Heymans MW, et al. The American Journal of Clinical Nutrition. 2020;112(1):84-95. doi:10.1093/ajcn/nqaa099.

6. Skeletal Muscle-Cardiac Muscle Aging: Shared Mechanisms and Multimodal Interventions. Kalra K, Berchie P, Singh S, et al. JACC. Advances. 2025;4(12 Pt 1):102347. doi:10.1016/j.jacadv.2025.102347.This is a thoughtful article, but it actually **reinforces rather than contradicts** the recommendation for this specific patient. The key distinction the article itself makes is between **sedentary individuals and active ones** — and a 71-year-old woman walking four miles daily is clearly in the active category.

Several points worth highlighting:

**The article agrees with higher protein for this patient.** The researchers quoted explicitly carve out exceptions for "the elderly" and exercising individuals. Lamming himself notes that "most of these really rigorous studies showing benefits of high protein diets are done in the context of exercise," and this patient exercises regularly. The closing expert quote states: "Exercising a lot could justify eating protein at existing American levels."

**The low-protein findings are preliminary and not applicable here.** The human study cited involved 22 lean men in their 20s over just five weeks — a population with fundamentally different metabolic needs than a 71-year-old woman at risk for sarcopenia. The article acknowledges that "no long-term studies of low-protein diets in humans exist yet" and that the researchers "do not recommend a low-protein diet for... the elderly."

**The mechanistic concern is about unused amino acids.** As the article explains, without exercise, extra amino acids "accelerate cell turnover" and cellular damage. This patient walks four miles daily, meaning she is actively utilizing dietary protein for muscle maintenance and repair — precisely the scenario where higher intake is beneficial.

The robust evidence from ESPEN, PROT-AGE, and recent NEJM reviews supporting **1.0–1.2 g/kg/day for healthy, active older adults** remains the appropriate guidance here.[1][2][3] The article's core message — that sedentary people may not benefit from high protein — is a reasonable hypothesis under investigation, but it does not apply to this patient's clinical scenario.

Would you like to explore the role of FGF21 and protein restriction in metabolic aging, and whether any of that emerging research has implications for active older adults?

### References

1. Malnutrition in Older Adults. Cruz-Jentoft AJ, Volkert D. The New England Journal of Medicine. 2025;392(22):2244-2255. doi:10.1056/NEJMra2412275.

2. Protein Intake and Exercise for Optimal Muscle Function With Aging: Recommendations From the ESPEN Expert Group. Deutz NE, Bauer JM, Barazzoni R, et al. Clinical Nutrition (Edinburgh, Scotland). 2014;33(6):929-36. doi:10.1016/j.clnu.2014.04.007.

3. Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group. Bauer J, Biolo G, Cederholm T, et al. Journal of the American Medical Directors Association. 2013;14(8):542-59. doi:10.1016/j.jamda.2013.05.021.

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