The Antisocial Doctors Podcast

Episode 11: How Much Protein Do We Really Need?

• Sonia Singh

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0:00 | 44:33

In this episode, we dive into the current obsession with protein—why it’s everywhere, why people feel pressure to hit high daily targets, and how even official messaging is fueling the conversation. We review what protein actually does, who may benefit from prioritizing it, why “more” isn’t always better, and how real-life constraints and the modern food environment may complicate the the outcomes of "eat more protein" messaging.

00:00 Podcast Mission Intro
01:19 Why Protein Is Everywhere
03:09 The Viral Protein Claim
04:24 How Protein Became Trendy
07:36 Optimization Culture and Inequality
10:45 New US Protein Guidelines
12:53 Protein Basics and Sarcopenia
15:02 Who Needs More Protein
16:10 How Much Americans Eat Now
18:54 Evidence Based Targets by Group
20:12 Lean Mass Caveat for Obesity
22:25 Why Protein Targets Creep Up
23:42 Who Actually Benefits
24:23 More Protein Without Training
26:39 Social Media Protein Hype
28:18 Plant Proteins Explained
29:57 Guidelines Graphic Critique
31:35 Protein Products and Marketing
33:39 When Supplements Make Sense
36:09 Barriers Beyond Willpower
37:33 Practical Takeaways and Trends
42:12 Resources and Wrap Up
42:48 Medical Disclaimer

📖 Read the full episode summary, sources, and resources on our Substack:
 👉www.theantisocialdoctors.com

Sonia Singh MD

You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety

Rebecca Berens MD

and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.

Sonia Singh MD

We're also a millennial women anxious moms and curious humans navigating social media. We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.

Rebecca Berens MD

This podcast is meant to be the antidote to your doom. Scrolling, a solve for the anxiety, stress, guilt, shame, and confusion. That comes from social media's messaging around health. In each episode, we discuss a health related talk trending on social media with curiosity, nuance evidence, humility, and compassion.

Sonia Singh MD

This is not your average debunking podcast we wanna explore not just what is trending on social media. But why? Why are so many people drawn to this? What is the nugget of truth here? What are the facts? What can we learn from this as patients and doctors? No shame. No blame, no snark.

Rebecca Berens MD

We're so glad you're here.

Sonia Singh MD

Hi Rebecca.

Rebecca Berens MD

Hi Sonia.

Sonia Singh MD

So today's topic has been one that I feel like I've been wanting to talk about for a long time. And actually as I was researching this topic, I felt like I kept coming across other things that I was like, oh my God, we should talk about this. We should talk about that. And I'm starting to feel this urgency about getting these episodes out.'cause I see just so much discussion about these things and they feel very, I don't know, topical and just relevant, and so anyway, I'm glad that we're at least starting with this one.

Rebecca Berens MD

Yeah, no, this is, this one is perfect. I'm super excited to hear what you found and have this conversation.'cause this is a near daily topic of conversation, whether with a patient or with a person that I just know socially. It's constant. So I'm really excited to talk about this.

Sonia Singh MD

Yeah, and actually I'm realizing right now that I don't I don't have a specific patient story for this one, but again, that's because I feel like I get asked about this on a daily basis, so it's impossible to pick one. But a very common experience I have is that a patient will come in and say. My trainer told me I need to be eating 150 grams of protein per day and I can't do it. How do I do it? And so yeah, a common question I get is am I eating enough protein? How much protein should I actually be eating? And I feel like the message that is coming through in the zeitgeist right now is that everybody needs to be eating more protein. I saw a funny meme and it was like I had to quit my full-time job so I could get enough protein. So anyway, it's clearly it's clearly a message we're all getting right now. I'm assuming you've heard the same

Rebecca Berens MD

Oh, absolutely. Absolutely. I think even from our politicians, there's been descriptions of yes. There's been a war on protein for all of these years and now the protein is coming back. We were apparently behind, behind the eight ball on protein for all this time. Yeah. Let's let's talk

Sonia Singh MD

about, yeah, let's get into it. Let's talk about that. So what is the claim? What I would distill down from it is just that all of us need to be eating more protein. We're not getting enough protein, and that protein is key to metabolic health, to battling weight gain, to building muscle, and we all just need to be. Prioritizing it more. I'm curious what your thoughts are on why it is so viral and why protein is just having its moment right now.

Rebecca Berens MD

Yeah, I think it feels like something attainable. To do. We've talked about this in other episodes, right? There's a lot of dietary changes that are really challenging to make. Yep. And it seems like something that's attainable and something that people can sell you to fix the problem. True, oh, we'll add, very viable. Yeah. We'll just add protein to all the things that you're already buying and now it's healthy because we added protein to it. So I think it's both a reaction to a problem that people are experiencing and I'm struggling to get adequate nutrition. And balanced nutrition in my day. And so the answer to that is, here's a product with protein added yes. That you can buy. And now it's, here's the easy button, right? This is how you eat healthy, buy this like protein stuffed, whatever it is, and now it's healthy. So that's where I feel like it's come from. But I'm curious what you found when you were. Going through this?

Sonia Singh MD

Yeah. Okay. So I would start with the same thing that I have started probably all of our, or like I've mentioned in all of our food and nutrition related episodes, which is just that I think nutritional science is just really a confusing area for people, not just for. The lay public, but even in medicine, it's just a messy science and things shift and change. And so sometimes what we thought 20 years ago or three years ago, we don't think anymore. And so I think, we don't get a ton of nutritional education in general education and then, even in medical education and sometimes, it's hard to keep up to date with what is the current thinking around this? And so I think it, I think it's just an area of just a lot of confusion for people. And not only is the knowledge base confusing. But the food environment is also so confusing and so overwhelming. Like the number of products that exist out there is insane. And like you said, the number of products, specifically targeting people, trying to eat more protein. I think the other day I walked into a Starbucks and just started laughing at the menu.'cause I was like. Protein foam, what on earth? Why are they putting protein powder in all of these things, so yeah, I'm just more and more amazed by like how many bizarre techno products have been created and just how confusing the marketplace can be. So I think that's a big part of it. I think we've lived through the low fat diet era and then we've lived through the low carb era. And protein is like the one macronutrient that has so far not been vilified, but I feel like it, I feel like it's time will come. Protein will Yeah. Eventually be canceled, I'm waiting for it to be canceled. But all the other macronutrients have at some point been canceled and protein. Seems to have this halo, it's like the golden child of the macronutrients, where almost no one will argue with you about eating protein. The other thing that I think is actually relevant for a lot of the topics we're gonna cover in this podcast is just that. The way fitness culture used to be, this very specific sub subculture and now fitness culture has just seeped into the mainstream. Things that I would only hear about from like my patients who were like bodybuilders or per like serious athletes are now trickling down to the general population in a way that I don't think they did before. And so I think that's a really interesting phenomenon. It's 20 years ago, 30 years ago, like it was really just bodybuilders that were talking to me about insane protein requirements in creatine. And now like the suburban moms are talking to me about protein requirements in creatine. So I think there's just overall like a shift in the culture around, food, nutrition, fitness, all of that. I think again, a theme we've seen a few times is that. COVID, like the pandemic put people's mortality and their health in clearer focus. I think a lot more people who had not really prioritized or thought that much about their health were suddenly like. How can I be healthier? How can I live longer? How can I boost my immunity? How can I improve my metabolic health? And so I think there's just, that's part of what's driven this whole excitement around longevity and optimization and all of, all of that stuff I think is born from that reckoning of oh my gosh, we need to get healthy. And then, I think. This is also a consequence of when you live in a society or an environment where there is so much abundance and there's less concern about deficiencies, the focus becomes optimizing everything, convincing you that it's not okay to just have enough and it's not okay to be normal, but you need to have the optimal amount. So I think we see that a lot, which is ironic'cause there's still so many Americans that live with food insecurity. But that's not what's showing up on Instagram. What's showing up on Instagram is somebody who's already very fit, talking about how to optimize your nutrition or your exercise routine for longevity. So

Rebecca Berens MD

yeah, I think that point I think is huge. Because that, that's something that, I've talked about this before, be, before coming onto private practice, I was working in mostly low resource settings, like safety net clinics. And it is crazy how, like you said, there are so many people who still don't have enough. They just don't have the basics. But the focus is so much more on the optimization and it is there's this sort of, because we're in a, overall higher resource country, a lot of people have access to everything that they need, and there is, it's a very it's a culture focused on consumption. And and, getting as much as you can, as much as more and more, more. And it's crazy how that then trickles down so that people who actually don't have the basics are then following the advice of the people who have everything that they need and more. And it's making them, it's it's just wor widening that gap even more. Yeah. Because If you're, if all you're hearing is about how to optimize, but you don't even have the basics, it's such a different way of thinking and a set of needs. But it's actually widening that gap that we have societally.

Sonia Singh MD

I totally agree, and it's it, so not only do the people who don't have the resources then feel this even, bigger discrepancy between what they're supposed to be achieving and where they are. But I actually think even people at the other end of the spectrum who are well-resourced and doing everything right for them, it creates this endless pit of oh, I'm never doing it. It makes everybody feel that they're not doing it, doing well enough, and I, yeah. I have a sweatshirt that says you are enough. And I feel like that is I we are this culture of, like you said, overabundance over consumption, and I think it's just in health, in health and healthcare and wellness. This is where we see that, where it's like nothing is ever enough and there's always like a striving for the next thing and the next thing and the next thing. So anyway. Yeah, we could. I'm sure we could wax poetic about the whole culture of optimization. We should probably do a whole episode on culture of optimization. Yes.

Rebecca Berens MD

But,

Sonia Singh MD

Okay. So that's one thing. The other thing that I didn't really have find any research on this. I'm sure there are essays on this topic somewhere, but it occurred to me that, protein is something that we associate with strength and power and Substance and maybe even masculinity, like the way people will say, yeah, okay, but what's the protein of this? What's the protein of this, meeting. And the no other macronutrient is like that. I don't think anybody, thinks about or talks about carbs or fats in that particular kind of way. So again, it has this weird halo, golden child kind of vibe around it, which is kinda interesting to think about. And then lastly, as you mentioned, it's not just tiktoks and Instagram and influencers that are telling us to do this. The US government is telling us to eat more protein. So as of January 7th, 2026, we published the new US dietary guidelines that were released by the HHS and the U-U-S-D-A and they basically increased the recommended. Daily protein intake for Americans from 0.8 grams per kilogram per day to 1.2 to 1.6 grams per kilogram to per day. So that's almost double what the previous recommendation was. So it's not just that it's viral and a hot topic and trending. It's actually been incorporated into the guidelines for, dietary recommendations for Americans. And then a common figure that, I didn't add this to the. Claim, but like a figure that I've heard patients say to me and that I've seen said on social media especially with people who are really into fitness and working with personal trainers, is a gram per pound per day, which is yep, 2.2 grams per kilogram per day. Which is a lot.

Rebecca Berens MD

Yes.

Sonia Singh MD

Yeah, I think, and when you're hearing that and your Dr. May be telling you, oh no, you're eating enough, 0.8, I think that creates this huge gap of, who is right? And what is the answer? And also what prompted this sudden change in the dietary guidelines and what are the old ones wrong Is are the new ones wrong? Like what, where is the truth in this?

Rebecca Berens MD

Yeah. And I feel like, I'm actually really curious. I don't know if maybe this will come up later, but I think that comes from eat your body weight and protein I think was a common, guideline that was given, which if you're going grams per kilogram is approximately yes, what we were saying. But it's just did people just misinterpret eat your body weight in protein because they think in pounds and we're like, oh or did they actually pull that from somewhere? I'm really curious what, I think it just was literally like I didn't understand the difference between a kilogram and a pound.

Sonia Singh MD

No, I, yeah, I don't think I wanna give them more credit than that. It's that they just misunderstood pounds and kilograms. I think. I think it's not just a conversion error but whether that number is really based on the best available evidence is pretty debatable. So anyway, let's talk about what is the negative truth here? So I think to talk about. All of this, we need to start with just the foundation about protein generally. So what is protein? It's an important macronutrient. It's important for a zillion functions throughout the body. It's one of your main building blocks. Proteins are made up of amino acids, of which there are 20 some of these. Most of them, your body is actually able to synthesize, but others must be acquired from the diet. Those are called the essential amino acids. And we all think of protein as helping build muscle, but they serve a bunch of different functions, serve as enzymes. They can be hormones, they can be neurotransmitters. Protein has a bunch of different roles beyond just mu muscle building. And there are serious, it's true that there are very serious consequences to not getting enough protein. So if you get down to say 0.4 or 0.5 grams per kilogram. You can start having muscle wasting, impaired muscle function, weakness, impaired immune function. When your protein levels are low, you can't hold fluid in your vessels and you can start developing swelling or edema. In children, inadequate protein can lead to stunted growth. It can impair their brain development. So protein is a very critical, important macronutrient. I don't wanna hate on protein. It is important and a word that I think a lot of people might be hearing right now if they're into health and wellness is sarcopenia. So sarcopenia refers to generalized loss of muscle mass and function which is highly correlated. Physical disability, poor quality of life, frailty, falls, even higher risk of death. And mostly, historically, we've thought about sarcopenia in the context of aging in an elderly population, but now we're hearing more and more about sarcopenia in younger patients who are maybe obese and have had dramatic weight loss with a GLP one or with some other means. And so you hear this about this phenomenon of sarcopenic obesity where somebody may have. A lot of adipose tissue, but they still may be losing muscle mass or have very low muscle mass despite having a larger body. I think this is all very I'm sure people are hearing a lot of these words or hearing a lot of the importance of protein. And I agree that it is extremely important and it's true that we are, that sarcopenia is a major concern and we're seeing more of it. So that's a general kind of intro to protein. Now, there are certain subgroups that are at higher risk for inadequate protein. So I mentioned some of them already. These are the same people that are at risk for sarcopenia, so older adults people with higher protein demands or metabolic demands. So need for more protein. That's like athletes, pregnant women, breastfeeding women, those with obesity who are trying to lose weight, who are at risk for muscle loss. Those going through menopause and have natural changes in their body composition that may lead to muscle mass, loss of muscle mass. So all of those people in those groups would probably benefit from consuming more protein. So when you think about all of those groups that actually, and does cover a large portion of the American population, a ton of people are aging, a ton of people are pregnant or breastfeeding or trying to, or obese and trying to lose weight. It's. It's not shocking to me that people would be concerned about this, and I do think it's a legitimate thing to wanna look into and make sure you're getting, an adequate amount. But I think to really get to the truth on this, you have to really, this is like a classic example of where the context and the nuances of it really make a difference. So first I wanna talk about what are Amer, what are we doing now? Where are we at with this? Because in nutrition school, like when I got my master's, their prevailing wisdom was Americans get enough protein, we just get enough, we just stop talking about protein.'cause we get enough fiber is where we really need to be talking to people about how they're not getting enough. But protein, we're doing fine on. There's a lot of debate about whether that initial, recommended daily intake of 0.8 was appropriate or whether it was an underestimate. A lot of people critique the studies that was based on for flawed methodology, and they say, oh, those were just done, in a way that really underestimates what people's needs are. And truthfully, I don't feel like I am qualified enough, in those methodologies to really be able to critique that in. Meaningful way from my standpoint. So I'm not even gonna go there. But, I think what we do know is that there, there is quite a bit of data in these certain subgroups that may not be adequate. And I think that's. That's where the real truth of the matter lies. So maybe 0.8 grams per kilogram per day is enough to prevent muscle wasting. But is that enough for somebody trying to build muscle? Is that enough for somebody trying not to lose it? Who is at risk of losing it? Is that enough for somebody with increased demands'cause of their activities or their. Pregnant state or the breastfeeding state or whatever. No. So the amount that Americans are typically consuming is 80 to 90 grams of protein per day, which comes out to 1.1 to 1.3 grams per kilogram per day. And that's based on NHANES data, which is a huge national survey that has gone on for years and years. And that data was between 2001 and 2014. So not, it has not been checked. I don't have the numbers as recently as this protein, current protein craze that we're in, but as of then, we were having 1.1 to 1.3. And as you may recall, I think I said the current recommendations were. 1.2 to 1.6 in the new guidelines? Yeah, so we're actually, for the most part we're doing okay on the protein. We're not all wildly deficient. There are some ages in ethnic groups where people are maybe not getting enough. Very few people were down in the 0.4 to 0.5 grams per kilogram range that's associated with the more severe consequences. The most important subgroup was older adults where the presence of sarcopenia is like 10 to 25%. So there is evidence that those people may not be getting adequate protein, but. Sarcopenia develops not only from inadequate protein, but from inadequate protein and or inadequate activity. Yeah. So it's not just an issue of protein because if you consume more protein but do not do the activity, there's not going to be a dramatic difference in body composition. So I wanted to go through a few of these subgroups and mention what kind of the evidence-based. Recommended amounts of protein would be for those subgroups. And I have references for all of these that are gonna be on the substack. So if you wanna learn more about any particular of these subgroups, you can go there and see the full. Study or analysis that led to that that range. But for older adults, which is the category that has the most robust data, there's still debate around what the ideal number is. Some people say just 1.0 grams per kilogram per day is adequate. And other people will say, really, the range of 1.2 to 1.6 grams per kilogram per day is adequate. I think that's really what. Maybe the dietary guidelines are most they're looking at that data the most, maybe to come to that conclusion that is the recommended amount. But most of that data does come from older adults. Pregnant women should be getting a minimum of 1.2 grams per kilogram per day in early pregnancy, but up at least 1.5 kilograms per kilogram per day in later pregnancy Breastfeeding, women should be getting 1.1 to 1.3 grams per kilogram per day. Menopausal women. Again, area of debate. There's a lot of different stigma on this, but somewhere between 1.0 and 1.6 kilograms per day is what probably they should be getting. Obese patients who are on a GLP one should be getting at least 1.2 grams per kilograms per day. But using the fat-free mass or lean body weight, which is a very important caveat. Yeah. I think over a third of adults at this point would qualify by BMI for obesity. And if you're using that weight as what you use to calculate your protein needs, you're probably overestimating them quite a bit because there's a lot of fat mass or adipose tissue that is not contributing to any metabolic demands. And so using that. Full weight is probably not. Accurate. And the fat-free mask can be calculated a few different ways. The best way to do it is to actually have your body composition done, which is not a thing that we standardly do in traditional primary care offices. You can often get it at a gym or through a trainer, different very, a weight loss practice. But you may not have access to that. There's different formulas you can use to estimate fat-free mass. There's no consensus on one formula that's the best for this. There's two or three out there that people seem to think are reasonable. But all that to say I hope going through those numbers gives you a sense of how individualized this range is and how many factors will influence it. The fact that it blew my mind that in early pregnancy there's kind of one target and then it changes in later pregnancy. So that just tells you How much this number can change based on how active you are, what your current body composition is, what your other metabolic demands are. And so it's really, yes, there are a bunch of subgroups that would benefit from more protein, but the exact needs are very variable and depend on a lot of factors that, it, it are not accounted for in this kind of blanket general recommendation that's now out there.

Rebecca Berens MD

Yeah. And it's interesting to me most of these ranges are include the, high end of the previous one, which was like 0.8 to 1.2. Yes. Most of these ranges around there. Some of them go again going up to 1.6, but I guess when I, when I used to counsel patients about that 0.8 to 1.2 grams per kilogram kind of estimate, I always would frame it as 0.8 is. The bare minimum you need to function and if you are doing more, then you are gonna need more to replace that muscle. So obviously it makes sense that yeah, if you're lifting weights and exercising a lot and trying to build muscle or if you're at risk of more muscle loss we need to make sure like it, so it makes sense to me. I'm still, I guess maybe you're gonna get to this, but I'm still struggling to see how we got up to this new recommendation that's very much on the high end or past most of these ranges. So I'm curious to hear how we get there, but I think it's really key also, like the we should do a whole episode on body composition because Yeah,

Sonia Singh MD

sure.

Rebecca Berens MD

Because I think that's the other thing that I think is, is entering into a lot of these conversations, but like you said, most people don't actually have access to that data.

Sonia Singh MD

Right.

Rebecca Berens MD

And so they're erring on the side of oh, I just need more then.

Sonia Singh MD

Yes.

Rebecca Berens MD

And because if you don't have the data to help you make the decision then, and you're trying to do the right thing, you're gonna err on I'm gonna make sure I hit the high range. So that I, because I don't wanna underestimate. And so maybe you're gonna get into this of what the risks of that are, but yeah. I'm. That I think would be a whole other conversation to have about how to help people better estimate their needs when we don't necessarily have access to the data to do that.

Sonia Singh MD

Yeah. So what I would say in terms, so you're correct that if you were having. At the high end of the previous guidelines, which is the low end of the current guidelines, you're probably in a pretty safe spot, yeah. So 1.2 feels like a pretty safe place to put your money when you're looking at all of these ranges for all of these different things. I don't know what made them specifically choose. I suspect it's mostly this data that it is in older adults and that is in active, very active adults where, you do see some benefit from higher intakes. But yeah, I don't know that the majority of people in the nutrition community would get behind saying that this is the right range for all Americans. So one big point that I wanna make here is that, all these subgroups we talked about, they either have increased metabolic demands or they're in some kind of catabolic state where they're at risk for muscle breakdown. And it's important to note here that if you're just an average adult and you start eating more protein beyond what your metabolic needs are without concurrent weight training or resistance training or activity, You're not really gonna get anything out of it. It's just, it's gonna go away. I will acknowledge that it. Relatively safe and, but so safe in terms of toxicity. So the upper limit of tolerability for protein is like 3.5 grams per kilogram per day, which is honestly really hard to do. So I'm not really worried about a lot of people doing that. But you have to ask yourself what is that protein replacing for you and what is coming with it in your diet? If you're adding that much so that, we're gonna talk about that a little bit later, but I do wanna make the point that even the new dietary guidelines acknowledge. That just adding more protein without any change in activity is unlikely to benefit you. This is a direct quote. They say, although dietary protein can increase muscle mass and strength when combined with regular strength or resistance training, there is little evidence that absent sustained training, higher protein builds muscle or provides other health benefits. So they're acknowledging right there that if you're not doing the activity piece and you just up your protein intake and you're just a regular person. Probably nothing is going to happen or nothing positive is going to happen. Happen, I should say. And unfortunately, most US adults are sedentary. And so if you're not falling into one of those subgroups that I talked about that are at risk, it's unlikely to benefit you in a meaningful way to just be adding more protein. So the biggest point that I want to make about this and the part that makes me feel so strongly that a lot of this messaging is coming from people who don't live in the real world and don't. Talk to patients on a regular basis. Is that snarky? I don't wanna be snarky. That's one of our rules is to not be snarky, but I just, it comes across to me as as it as people don't realize, like how this is going to translate in real life to actual people who are going about trying to decide what to eat. Yeah. I think that when people hear this message of, oh look, the new dietary guidelines say we should eat more protein. No one's really sitting and reading the 10 pages of the guidelines that are printed for the way public. They're just getting this message and we're seeing it all over social media of you gotta be eating more protein, right? When they think eat more protein, at least most, the vast majority of the patients I talk to, they think meat, eggs, fish. Maybe they're thinking Greek yogurt. Cottage cheese, protein bars, protein shakes, protein powders. Yeah. That is mostly what comes to mind for the majority of Americans who are accustomed to the western way of eating. Those are mostly animal sources of protein or ultra processed foods, which we as Americans already consume way too much.

Rebecca Berens MD

Yeah, way

Sonia Singh MD

too much of right. There's very few things in nutrition that I feel really confident are true and gonna be true for a long time. And one of those things is that I think we see over and over. That the healthiest way to eat in terms of cardiovascular risk, cancer risk, inflammation, so many different things. Longevity is a whole foods plant-based diet that is low in ultra processed foods or a Mediterranean style diet and. The changes that I think would be prompted for the vast majority of Americans from hearing the message of I'm not eating enough protein, I need to eat more, are not really in line with those.

Rebecca Berens MD

Yeah.

Sonia Singh MD

With that dietary pattern. And so we should ask ourselves does this recommendation move most Americans closer to what we know is the healthiest way to eat? Or does it move them farther from it? And I want to acknowledge that protein can come from a lot of different sources and the guidelines just state, like I looked through and they have one line that's like. Protein should come from a mixture of plant and animal sources, but I don't think they really emphasize this, that plant-based plants can be also a source of very high quality protein. It's true that, animal sources are often a lot of bang for your buck and contain the essential amino acids and. If something contains all of the essential amino acids, the ones that you cannot synthesize, you consider it a complete protein. But there are actually plant sources that are also complete proteins that I think people just don't realize. So general sources of plant-based protein are things like lentils, legumes, grains, nuts, seeds, soy products. Examples of complete plant-based proteins are things like tofu, tempe, edamame, hemp seeds, chia seeds, quinoa, buckwheat, nutritional yeasts, spirulina. There's a lot of them. But those are the things, those are not the things that most people are going to immediately go to. Those are not the things that are readily available for most people in their environments or in the places that they're eating and shopping frequently. And so I think that, there's this tendency to lean on those animal sources and to immediately jump to those. But when you consume protein from an animal source, it's coming in with. Saturated fat. Often it's coming in with sodium and other things that are, it's not pure protein. It's coming with other stuff that typically we don't need more of. Whereas the plant-based proteins are gonna be coming in with fiber and antioxidants and all of these other, phytochemicals things that, you won't be getting as much of from meat products and. I wanna be fair to these guidelines. They did mention that there are plant sources of protein, but when you look at the, I don't even know what you call it. Is it a pyramid? I don't know. A new,

Rebecca Berens MD

yeah,

Sonia Singh MD

the upside down pyramid. A new triangle, I don't know. Maybe I'm not seeing, I don't even see beans on here and beans like the unsung hero of nutrition. It just breaks my art. That beans didn't make it onto the graphic. And the things at the very top are just meat. They're meat and vegetables. Meat and

Rebecca Berens MD

cheese.

Sonia Singh MD

They're meat, cheese, vegetables,

Rebecca Berens MD

cheese. Like why is the cheese on top? Several lines above the avocado and the egg.

Sonia Singh MD

It makes no sense. And why, why is, why are oats and nuts like so low down, yeah. And I don't know, to me, like I've had my own journey with my own nutritional knowledge for so many years. I don't counsel people the way I counseled them 10 years ago or even maybe five years ago. One of the big. Schemes of these guidelines is eat real food. And I think I mentioned one of my other episodes, I went through a whole phase where I was like, I'm only eating real food. Everything else is poison. Like I've been there, I've been there, I've done that. Yeah. And I have a lot of patients who I think perceive that the healthiest possible meal is. A hunk of lean protein and a bunch of veggies. And it's a challenge to convince them actually, no, it's okay to eat grains. It's okay to eat a whole grain. It's okay to eat a starch. It's okay to eat fruit. It's okay to eat these other things that are not just protein and veggies. And I think that's just a collective misunderstanding that we seem to have come to. These guidelines are falling into that kind of misunderstanding without acknowledging no, that actually that is not the ideal meal, and that is not what the evidence tells us we should be eating.

Rebecca Berens MD

Yeah. Anyway. I think also like to your point about what does this actually translate to for a patient? It doesn't translate to them eating real food, as you said, and you know what I what I see, and I'm sure what you see also, and what I think we see in on social media is a lot of marketing of products that have added protein, right? That are in no way anything like a real food or if we're gonna, in quotes, real food, right? They're not a whole food, they're not a. If your line is gonna be eat real food and then your other line is you need to eat this much protein, it is not going to happen in that way for most people.'cause like you said, it, the ability to actually sit and prepare a cooked meal of meat and vegetables for each meal is just not gonna happen. And. The way that most people need to get their protein sources in is in more shelf stable and easier to access and easier to prepare ways. So yeah, that's why beans are so great because you can them and they can sit on your shelf forever and they take five seconds to make versus cutting all the pieces off of fat off a steak and then grilling it. Yes. And it just is not gonna happen. And but it's just, it's so interesting how. By outta one side of your mouth, you're saying eat more real food. And out of the other side you're saying you need to eat this much protein by default. What EV everyone is gonna go to is here's this product with added protein. Yes. So now I can buy it and I can hit my needs and yeah. Now you're eating like. A Frankenstein waffle.

Sonia Singh MD

Yes. The Frankenstein is a great word for it. I had a couple come see me a couple weeks ago. Lovely couple really motivated to eat and be healthy and make the right choices and just trying so, so hard. But then, they're telling me yeah, we eat protein bagels and then I eat these protein chips as my snack, and I'm this is, this is a big misconception where I know that you're trying to do the right thing. You're motivated to, you have the resources, you have the time, but you think that these things are serving you and they probably are not. And they're just all their other ultra processed foods, yeah. And

Rebecca Berens MD

they're more expensive.

Sonia Singh MD

They are more expensive. It's true. Yeah.

Rebecca Berens MD

And and I don't wanna demonize the Frankenstein waffle because I. Frankenstein waffles can be really beneficial. And I do recognize I see a lot of patients who are recovering from eating disorders and who really struggle with, certain types of foods, certain textures, patients maybe with a I who like really can't get their protein in from, these typical meat and bean sources just for those reasons. And they have a place. And I just, I wanna acknowledge that'cause I don't wanna say that there's wrong to eat these things. But I think to try to. Push everyone towards that and away from other cheaper options is also not beneficial. And it just it creates a lot more confusion. And like you said, it's really, it's pushing people to spend more money on foods that are not serving them as well as cheaper, easier for more basic foods, could serve them.

Sonia Singh MD

No, I totally agree with you. And my kid, my kids eat plenty of Frankenstein products. Oh yeah. So I am not I am not completely opposed to the Frankenstein products, but if I were to rewrite these guidelines, I would've wished that there would've been a stronger emphasis on thinking about the source of protein and the quality of that source of protein, prioritizing plant-based proteins, which we know, Americans don't eat very much of. And then. Having a mentioning if you're unable to reach your protein goals with Whole Foods which is very possible and realistic. That that's it's probably a common problem. I have plenty of patients that are trying to eat a little bit more protein, but. Their cholesterol is high, so they really don't wanna be having more animal products or more, meat. And they feel like, oh my God is there anything for me? I can only eat so much beans and lentils, and so I think for them it is reasonable to do, I have vegetarians who they do need to do a little bit of protein powder or something to get there. And I think having a caveat that's yes, you can you can consider use of some of these products to help you reach your goals, but be aware of what you're replacing with those, or that, they may not always be necessary or they may come with other added things that you don't actually need more of. So anyway I feel. I don't feel as angry about the actual, number that they've chosen as the requirement for the protein. But I think this is one of those cases where thinking about the context and the nuance and how this actually translate translates in real life to people is really key. And I'm concerned that this is going to translate actually into worse health outcomes based on people relying more heavily on animal products that we already know to not be. As supportive of long-term health and, good health.

Rebecca Berens MD

Yeah. And like you said, in terms of the thinking about what's actually actionable and sustainable for people to add into their life. That is maybe you could argue is not, shouldn't be part of the dietary guidelines, but I would not argue that. I think that there is a real gap here in acknowledging how we got to this point of not eating. As much, quote unquote real food. And what are the societal barriers that are in place that have gotten us there? Because it does really. Again, push this towards this is a an individual choice problem. You can just choose the thing with more protein added and then you'll be meeting these guidelines. Yeah. Versus Hey, why do you have to work three jobs to be able to feed your kids and you don't have time to cook? So then you're picking up stuff. There's a lot of, there's a lot of factors there that are affecting people's ability to eat real food that has very little to do with what people are. Consciously choosing and more to do with what is accessible and available and, sustainable for them to fit into their life.

Sonia Singh MD

No, that's totally true. And actually I have to go back and look at it again to see if they even mentioned this, but people's dietary choices don't exist in a vacuum, and so some acknowledgement of just what drives dietary choices and how those, how that happens, I think that would be a great addition to the dietary guide,

Rebecca Berens MD

And what we're doing as the government to better support everyone in being able to make better choices. Didn't see a lot of that. But anyway.

Sonia Singh MD

No. Okay. We always like to end the episode with what can we take from this as doctors and as humans, and I would say. As doctors, I think again, we just have to remember people are so hungry for this knowledge and they want to know. And if you don't know and you don't talk to them about it, they're going to go to another source that may not be as evidence-based. And so I think it's important that we maintain our nutritional knowledge and have some familiarity with these numbers. And also just emphasize that it is not a one size fits all thing. The guidelines are the guidelines, but you really should be thinking about your individual situation and talking to some kind of professional about how, how that relates to you and how that can apply to you. I think that if a patient comes to me and mentions that they're wanting to increase their protein intake, I would try to start with. Kind of getting an estimate of maybe what they're consuming now, what their level of activity is, what their needs are. I think that's just step one. As we talked about, you may not ever, I don't have a body composition machine in my practice. I may not ever have a totally accurate number. I think that, 1.2 grams per kilogram per day range is like a pretty. Safe range to start with for kind of your average adult. I acknowledge that most people in their primary care practices are not gonna have time to take like a full dietary history on somebody and may not have time to have this conversation. In that case, you can lean on your registered dietician colleagues, although I will also acknowledge that often you cannot see a registered dietician unless you have a diagnosis that your insurance will cover the dietician for. So there are many barriers to having these conversations in real life and getting the kind of, support some people are wanting around this. I think also just, just acknowledging or validating for patients that this is just a really confusing, this is a really confusing space and the marketplace is really confusing and can be really overwhelming. I just, I hear that a lot from patients. I had a patient who was just like, I don't know, I was standing in the yogurt aisle and I just didn't know what to pick. And so I didn't buy any of them because I was just so confused. And I don't think, as the doctor. Most of the time you're not gonna have the answer of this is the product and that's not what you need to do. But just validating that yeah, that's hard. That is really hard. And like you said earlier, consuming real food, having following the dietary guidelines is also hard and it's not easy and it's not realistic for a lot of people to achieve that, all the time. Yeah. And then. I think as patients, I would just give people the reminder that on average most of us are actually probably meeting or pretty close to the guidelines. This feeling of scarcity of none of us are getting enough and we're all wasting away. I don't think that's actually true. And we do need to be mindful about how much we're consuming, but the advice that's right for your friend or your sister or the guy down the street, or your trainer may not be the right advice for you. So don't feel, be wary of comparing yourself to others. And also just remember that there are trends in nutrition, just like there are trends in everything else. Just like there's trends in fashion and what body type is popular. We're in a protein era right now, but there're gonna, there's gonna be a new era at some point. Yeah. So take all of this messaging with a grain of salt. That's how I see it, is okay, we're on this, we're on this train now. But I really hope the next train is fiber.'cause I really love fiber and I,

Rebecca Berens MD

so I, I love fiber too, that has already started with the whole fiber mounting.

Sonia Singh MD

But fiber maxing.

Rebecca Berens MD

Which, which absolutely needs to be a future episode about fiber maxing. But I also think fat's kind of coming back, but fat, everyone was anti-fat for a while. Then there were anti carb. Eventually people are gonna be anti protein soon. There's not gonna be anything that we're allowed to eat anymore.

Sonia Singh MD

That will be a dark time.

Rebecca Berens MD

So I think, you and I both love our dietician colleagues and and that is, even though we both have a lot of time, I still heavily rely on me too dietician colleagues because they do have more education in this than I do. I think I probably have more nutrition education than maybe the average doctor, but not anything like what a dietician has. And so I do really think it's important to, to keep that in mind. But yeah it's a confusing world out there.

Sonia Singh MD

My husband actually told me about fiber maxing a few weeks ago, and he said he listened to a podcast episode about it, and I was like what is it? And he's they basically just said eat a bunch of high fiber foods to get a lot of fiber. So anyway, I don't know if that's what it's, but I was like, okay, I can, is that a trend I can get behind? I like that

Rebecca Berens MD

Until the horrific GI issues start because people are overdosing themselves on fiber.

Sonia Singh MD

Okay. Yes. I that we should add that to our list of topics.

Rebecca Berens MD

Oh yes, absolutely.

Sonia Singh MD

Absolutely. I would love to talk about fiber and fiber maxing. Okay. Where can people go for more info? We are gonna put links to our substack in the show notes. Our substack will house a written summary of our discussion today, all of the links and resources. There are a ton of references for this episode. And then I have a couple of patient friendly. Links as well that are sourced and vetted and you can go there yourself if you're a patient or if you're a doctor, you can send patients there as well as a few experts on Instagram and social media to follow, to balance out some of the other content you might be seeing.

Rebecca Berens MD

Thanks. So this was a great conversation.

Sonia Singh MD

Yep. So that brings us to the end of the episode. Thanks for joining us.

Rebecca Berens MD

Thanks.

Sonia Singh MD

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