Physicians can cut through the barrage of information on protein with some commonsense guidelines and myth-busting.

Protein’s decades-long reputation as a weight-loss and muscle-building tool has been pushed even higher recently — with the federal government boosting recommendations, influencers promoting 200 grams a day on TikTok, and GLP-1 users being told to eat more of it.

All of this landed on fertile ground: A survey last year showed that a third of Americans were already trying to eat more protein. But only 1 in 5 said they knew exactly how much to aim for — and most of those people were wrong.

“Despite protein’s elevated level of interest, there’s still dogma that we’re overproteined and that protein only comes in the form of steak,” said Michael Ormsbee, PhD, director of the Florida State University Institute of Sports Sciences and Medicine. His primary area of research is protein’s effect on human health.

Ormsbee said that although the new guidelines have stirred controversy, when it comes to protein they’re right on the money. He said researchers who “do the actual work” have been promoting similar goals, “so people don’t need to be scared of it.”

So what do patients need to hear from their doctors about protein? Start with the basic amounts.

How Much Protein Do Your Patients Need?

The new Dietary Guidelines for America suggest an optimal protein range for most people of 1.2-1.6 g/kg of body weight. This represents a significant boost from the long-standing Recommended Dietary Allowance of 0.8 g/kg, established decades ago as the minimum to prevent deficiency. While public health advocates, the American Heart Association, and the Academy of Nutrition and Dietetics have criticized the guidelines for prioritizing animal-based proteins over plant sources, many experts have welcomed the higher target.

“I like the bump up,” Ormsbee said. “Twenty years of working in protein for me, and many more from other protein researchers, show that 0.8 was okay for preventing wasting diseases and medical problems. But it’s certainly not in a range that was optimal for other areas of your life.”

Many of your patients are likely at or near the new level. Nearly all men ate at least 1.2 g/kg, according to What We Eat in America, based on the National Health and Nutrition Examination Survey from 2017 through March 2020. (Only men 71-plus fell a little short.) Women, on the other hand, could use a bit more — while every age group ate at least 1 g/kg, only girls younger than 13 years consistently hit 1.2 g/kg each day.

Some context: To stay in the range of 1.2-1.6 g/kg, a person who weighs 150 lb would need to eat between 82 and 109 g of protein each day. If a patient mentions the 200 daily grams they saw on social media, tell them that sounds just right — for someone between 275 and 365 lb. For anyone smaller who isn’t a bodybuilder, that extra protein is likely going to waste.

Ormsbee said almost everyone should aim for 1.6 g/kg. Here are some who definitely should:

• Patients older than 50 years who are experiencing anabolic resistance, in which their bodies need more protein to achieve the same results they’re used to.
• Patients whose bodies are growing, including children and pregnant women.
• Patients whose bodies are recovering, such as from surgery or the flu.
• Patients using GLP-1 medications, which puts them at risk for losing muscle mass.
• Patients who are extremely active, especially if they’re trying to put on muscle.

“There’s no data, really, showing that outside of that, higher is all that much more beneficial,” Ormsbee said.

Here’s a colorful reminder that may stick with patients: Excess protein merely becomes expensive urine, said Hope Barkoukis, PhD, RDN, chair of the Department of Nutrition at Case Western University School of Medicine in Cleveland.

“If you eat an excessive amount of protein, it’ll be broken down,” she said. “One part of it will be made into other compounds, but the other part will be urinated out.”

Three Protein Tips to Share With Your Patients

The right amount isn’t the only key. How and when your patients get their protein also matters. Offer these tips:

Eat some protein all day long. “One of protein’s many functions is to promote growth, repair, building,” said Barkoukis. “By spreading it out, distributing it throughout the day, you’re going to have more time when your system has higher levels such that it’s in an anabolic state, vs just one big bolus at one meal a day.”

Tell patients to try for 20-30 g of protein at each meal and end the day with a protein-rich bedtime snack; think Greek yogurt or cottage cheese. (If questions come up about full-fat dairy vs low-fat, refer to this article.) Research suggests that consuming protein before sleep helps muscle protein synthesis continue through the night.

Add plant-based protein to your diet. The new dietary guidelines recommended eating more protein, and the inverted pyramid visual puts steak and a whole chicken at the top — but saturated fat remains a concern. The guidelines didn’t change previous recommendations, so your patients should still get no more than 10% of their daily calories from saturated fat. Easy ways to increase protein without increasing saturated fat: Add beans, tofu, and other plant-based proteins to the shopping list.

Get most of your protein from whole foods. The new dietary guidelines remind people to avoid highly processed foods, which have been linked to chronic illness. So while protein powder is convenient (in fact, Ormsbee suggests a protein shake before bed, if you wouldn’t otherwise get that extra boost), most of your patients’ daily protein should come from whole or minimally-processed foods.

Understand Patients’ Misconceptions About Protein

Some myths about protein persist despite (or maybe because of) all the advice floating around. Offer some clarity:

Most healthy patients don’t need to worry about eating too much protein. Kidney damage is often cited as a risk for prolonged excess protein consumption, but the research isn’t clear. Longitudinal data with extremely excessive protein intake (like 4.4 g/kg) doesn’t show “any problem in generally healthy people with kidney function,” Ormsbee said. There is, however, some cohort-based research connecting more than 1.8 g/kg to cardiovascular disease and all-cause mortality among adults older than 55. (And of course, there’s the “expensive urine” argument to keep in mind.)

Protein doesn’t automatically give them muscle. Research shows that for patients rapidly losing weight with GLP-1 medications, between 20% and 50% of the total loss may come from muscle mass. Increasing protein intake can help, but adding resistance training shows the most benefit. While it’s true that protein’s primary job is to grow and maintain tissue, it doesn’t build muscle on its own. “There’s this myth that if you eat protein, voila! Superman is in your sights,” Barkoukis said. “You absolutely need to have a well-defined program of resistance training.”

They shouldn’t neglect other nutrients. High-protein, low-carb diets for weight loss have been popular for decades, but focusing solely on protein can lead to deficiencies elsewhere.

“If you’re eating at the cost of other macro and micronutrients, then you’re missing out on fiber and colorful vegetables and fruits and these carbohydrates that have all these other micronutrients and phytonutrients and health benefits,” Ormsbee said.

When patients are frail or in poor health, they — or their caregivers — may think protein is the key to restoring strength. But it must be balanced with other nutrients.

“If you aren’t getting enough calories — if the person is ill, for instance — they will not use protein for typical protein functions,” Barkoukis said. “They will break it apart and use it as an energy source.”