High protein consumption in trained women: bad to the bone?

High protein consumption in trained women: bad to the bone?

This is the first investigation to examine the effects of a chronic high-protein diet (2.8 g/kg/d) in exercise-trained women. In the current study, the high-protein group consumed 87% more protein than the control. The ~ 226 kcal difference in energy intake (high-protein > control) is largely due to the increase in protein consumption. It should be noted that the high-protein group exhibited a wide variation in intake (mean±SD 169±55 g/daily). This was largely due to one subject that consumed in excess of 4 g/kg/d of protein. Nevertheless, in spite of a significantly higher protein intake, there were no changes in bone mineral density, bone mineral content (i.e., whole body, lumbar spine) or T-score. There have been other investigations that have made direct measures of bone health after the consumption of a higher protein diet. Kenny et al. evaluated the effect of a 1-year treatment that consisted of dietary soy protein and/or soy isoflavones on bone health in late postmenopausal women [7]. They found that neither soy protein nor isoflavones (in combination or alone) had any effect on BMD. It should be noted that the protein intake from that study was actually quite low (~ 0.9 g/kg/d) [7]. Ballard et al. conducted a 6-month investigation on protein supplementation and bone health [8]. They discovered that additional protein had no effect on BMD or bone size in young adults (18–25 years). It should be noted that the protein intake of the subjects in the Ballard et al. investigation was quite low as well (1.0–1.2 g/kg/d). Moreover, in older women and men (> 60 years), whey protein supplementation (total daily protein intake of 1.0–1.1 g/kg/d) had no effect on bone mass; however, it did increase truncal lean mass after an 18-month treatment period [9].

It must be acknowledged that the protein intake of the aforementioned studies was quite low. Athletes or individuals that exercise regularly are often advised to consume at least twice the recommended daily allowance (RDA) of protein [1014]. The protein intake in our investigation was 1.5 and 2.8 g/kg/d for the control and high-protein groups. It should be emphasized that the protein intake from our control group exceeded those of other studies [79]. So perhaps in order to observe a change in bone parameters, a much higher dose is needed. Our high-protein group consumed protein at a dose 2.5 times greater than the RDA. Thus, if there were a deleterious effect of protein consumption, one would reasonably expect to see this at such a high dose. On the contrary, our investigation found no effect on bone mineral content or density.

This is in agreement with other studies that have utilized moderate to high protein intakes. Cao et al. provided post-menopausal women with a diet of 1.7 g/kg/d of protein for 7 weeks and found no adverse effects on bone health [15]. Ballard had young (18–25 years) subjects consume 2.2 g/kg/d of protein over a 6-month treatment period [8]. Although they did not measure bone mass directly, they discovered that biomarkers for bone formation were elevated (e.g., IGF-1). Moreover, in the presence of high calcium intake, consuming a high-protein diet (2.5 g/kg/d) for one month in hyperlipidemic men and women (56 years) did not have a negative effect on calcium balance [16]. However, the treatment period was rather short and they did not make any direct measures of bone mass.

Our investigation is the first to use exercise-trained women. This is significant in that it is exercise-trained individuals that purposefully consume a higher protein diet [2, 10, 11, 13, 1723]. Sedentary individuals do not typically consume a high-protein diet. And it is clear that a very high intake of protein (2.5 x greater than the RDA) does not have a negative effect on bone mineral content or density.

Another interesting find in our investigation was that despite consuming more calories per day, the high-protein group did not experience a change in fat mass. This supports work from other investigations [10, 2426]. In fact, when combined with a change in training, a higher protein diet can promote a loss of fat mass [10]. It is unclear why fat mass might decrease in response to protein overfeeding combined with a change in one’s training program. Perhaps it is non-exercise activity thermogenesis or diet-induced thermogenesis with increased protein consumption [27, 28]. Also, animal data suggests that a high-protein diet might reduce fat mass by inhibiting lipogenesis in the liver [29]. Nevertheless, the current investigation demonstrated that body composition as well as bone mass does not change unless in the absence of alterations in the exercise stimulus.

It should be noted that the total energy intake of our subjects seemed rather low for active individuals. For instance, the control and high-protein groups consumed on average 1580 and 1877 cal per day. A simple estimation of basal metabolic rate using the Harris Benedict equation would suggest that at minimum these individuals should be consuming greater than 2000 cal per day [30]. Thus, it is likely that our subjects were underreporting total energy intake, particularly from carbohydrate and fat. It is however plausible that protein intake was more accurately estimated inasmuch as subjects derived the added protein from protein powder sources. Nonetheless, despite the drawbacks of using dietary records, it is evident that extra protein supplementation has no harmful effect on bone mineral content or density.