JOURNAL OF DIETARY SUPPLEMENTS

, VOL. , NO. , –

https://doi.org/./..

REVIEW

Protein Supplements: Pros and Cons

a
Jay Rabindra Kumar Samal and Indira R. Samal, MScb
a
Department of Biotechnology, Manipal Institute of Technology, Manipal, India; b Department of Biochemistry,
Punjab Institute of Medical Sciences, Jalandhar, India

ABSTRACT KEYWORDS
To provide a comprehensive analysis of the literature examining the dietary supplements;
pros and cons of protein supplementation, various articles on protein metabolism; protein; protein
supplementation were obtained from Google Scholar, PubMed, and nutrition; protein safety
National Center for Biotechnology Information. Over the past few years,
protein supplementation has become commonplace for gym-goers as
well as for the public. A large segment of the general population relies
on protein supplementation for meal replacement, weight reduction,
and purported health benefits. These protein supplements have varying
pros and cons associated with them, which are often overlooked by the
public. This review aims to assimilate existing studies and form a consen-
sus regarding the benefits and disadvantages of protein supplementa-
tion. The purported health benefits of protein supplementation have led
to overuse by both adults and adolescents. Although the pros and cons
of protein supplementation is a widely debated topic, not many studies
have been conducted regarding the same. The few studies that exist
either provide insufficient evidence or have not employed proper con-
ditions for the conduct of the tests. It should be considered that protein
supplements are processed materials and often do not contain other
essential nutrients required for the sustenance of a healthy lifestyle. It
is suggested that the required protein intake should be obtained from
natural food sources and protein supplementation should be resorted
to only if sufficient protein is not available in the normal diet.

Introduction
Around 10–15 years ago, protein supplements were solely consumed by bodybuilders and
others indulging in heavy exercise. Over the past 5 years, however, protein supplements have
become commonplace for both gym-goers and the public. A large segment of the general
population relies on protein supplementation for meal replacement, weight reduction, and
purported health benefits (Bartels & Miller, 2003). These supplements act as sources of protein
while on the go, as they require less time for preparation and may cost less than traditional
sources of food. Protein supplements are also preferred over traditional sources of protein
because of their ease of availability and use.
According to Euromonitor figures, it was estimated that the world will be consuming eight
billion euros (€8 billion) a year of bars, drinks, and other protein supplements by 2017 (Global
trends in protein, 2016).

CONTACT Jay Rabindra Kumar Samal [email protected] Department of Biotechnology, Room , th Block,
MIT Hostels, Manipal Institute of Technology, Manipal, Karnataka , India.
©  Taylor & Francis Group, LLC
366 J. R. K. SAMAL AND I. R. SAMAL

These protein supplements have varying pros and cons associated with them, which are
often overlooked by the public. Many studies have been carried out, the results of which
are both for and against the use of protein supplements. This review aims to assimilate
existing studies and form a consensus regarding the benefits and disadvantages of protein
supplementation.

How much protein do we really need?

The recommended dietary allowance (RDA) for protein for the United States, which is the
average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–
98%) healthy people, is 0.8 g protein/kg body weight/day for adults, 1.5 g protein/kg body
weight/day for children, and 1.0 g protein/kg body weight/day for adolescents (http://www.
nationalacademies.org/hmd/Activities/Nutrition/SummaryDRIs/DRI-Tables.aspx). How-
ever, it is widely accepted that physically active individuals may require protein intakes of up
to 1.4–2.0 g/kg/day (Campbell et al., 2007).
Due to the lack of many controlled studies and the presence of starkly contrasting results
in other studies, it is not possible to form a consensus regarding the benefit of protein supple-
ments in exercise training. However, it was found that the stimulatory effect of amino acids
after exercise was greater than the effect of amino acids on muscle protein synthesis when
given at rest, which suggests that not only may the exact composition and amount of a pro-
tein supplement be important, but the timing of ingestion of the supplement in relation to the
exercise must also be considered (Wolfe, 2000).
The adverse effects associated with long-term high protein intake in humans include
disorders of bone and calcium homeostasis, disorders of renal function, increased cancer
risk, disorders of liver function, and progression of coronary artery disease (Delimaris, 2013).
However, these symptoms were observed only when protein intake exceeded the RDA. The
literature review of 32 studies concluded that there was no reasonable scientific basis to
recommend protein consumption above the RDA for healthy adults due to the associated
potential disease risks.
As dietary protein provides amino acids that are needed for the synthesis of muscle protein
and have a stimulatory effect on muscle protein synthesis, the RDA for protein needs to be
raised in older people to protect them from sarcopenic muscle loss (Wolfe & Miller, 2008).It
has been suggested that an intake of 1.5 g protein/kg/day, or about 15%–20% of total caloric
intake, is suitable for elderly individuals wishing to optimize protein intake in terms of health
and function. However, longer-term trials are needed to define optimal protein intakes in
older adults (Paddon-Jones & Rasmussen, 2009).

Benefits of protein supplementation

Dietary protein can decrease delayed onset muscle soreness as compared with water when
ingested prior to muscle-damaging exercise in active men and women (Haub et al., 2014). The
study aimed to compare the effects of protein supplements on delayed onset muscle soreness
(DOMS) in active men and women. The participants consumed a protein supplement, rested
for 90 minutes, then ran on a treadmill at 75% peak heart rate for 30 minutes. DOMS was
assessed with a tension gauge post-run.
A meta-analysis of interventional evidence found that protein supplementation increased
muscle mass and strength gains during prolonged resistance-type exercise training in both
 JOURNAL OF DIETARY SUPPLEMENTS 367

younger and older individuals (Cermak et al., 2012). Data of fat-free mass and one repetition
maximum (1-RM) leg press exercises were collected from 22 randomized controlled trials to
investigate the effect of protein supplementation during prolonged (>6 weeks) resistance-type
exercise training.
Twenty-four college-aged men who consumed 48 g of whey isolate every day showed that
lean body mass, muscle mass, strength, and power all increased and fat mass decreased (Joy
et al., 2013). Although the study found that rice protein isolate had similar effects, whey
isolate consumption led to better results with lesser dosage, which could be because plant
protein sources are often lower in one or more essential amino acids, thereby failing to match
the requirements of a complete protein. However, the study was limited by the lack of a
nonsupplemented control group and short duration of research.
It has been demonstrated that whey protein and food protein sources are equally effective
at improving physical performance and cardiometabolic health in obese individuals (Arciero
et al., 2016).
A randomized controlled trial was conducted among 352 adults with prehypertension or
stage 1 hypertension to validate an inverse association between dietary protein intake and
blood pressure (BP), reported by observational studies. The results from the trial indicated
that both soy and milk protein intake reduced systolic BP, and there was no significant differ-
ence in the BP reductions achieved between soy and milk protein supplementation (He et al.,
2011).
It has been suggested that dietary protein intake may not decrease the risk of stroke (Zhang
et al., 2016). The meta-analysis included 12 cohort studies involving 528,982 participants.
However, it was suggested that dietary vegetable protein intake may decrease the risk of stroke,
the mechanisms of which are still not completely understood. However, all the participants
of the included studies were also involved in intake of other nutrients such as cholesterol and
fat at the same time, which could have influenced the results.
There is a lack of association between dietary protein intake (both from natural sources
and from supplementation) and the risk of ulcerative colitis (UC; Wang et al., 2016)). Nine
studies were included in a meta-analysis with a total of 975 UC cases and 239,352 controls.
The analysis suggested the lack of a nonlinear dose-response association between the nutrient
intake and UC risk, except for a subtype of sucrose.
The International Society of Sports Nutrition states the following (Campbell et al., 2007):
1. Research supports the contention that individuals engaged in regular exercise require
more protein than those leading a sedentary lifestyle.
2. Protein intakes of 1.4–2.0 g/kg/day for physically active individuals not only is safe,
but may improve training.
3. When part of a balanced, nutrient-dense diet, protein intakes at this level are not detri-
mental to kidney function or bone metabolism in healthy, active persons.
4. While it is possible for physically active individuals to obtain their daily pro-
tein requirements through a varied, regular diet, supplemental protein in vari-
ous forms is a practical way of ensuring adequate and quality protein intake for
athletes.
5. Appropriately timed protein intake is an important component of an overall exercise
training program, essential for proper recovery, immune function, and the growth and
maintenance of lean body mass.
Concerns that protein intake within this range is unhealthy are unfounded in healthy, exer-
cising individuals. An attempt should be made to obtain protein requirements from whole
368 J. R. K. SAMAL AND I. R. SAMAL

foods, but supplemental protein is a safe and convenient method of ingesting high-quality
dietary protein.
White blood cells (WBCs), red blood cells (RBCs), hemoglobin (HGB), hematocrit (HCT),
mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpus-
cular hemoglobin concentration (MCHC), platelets (PLT), and percentage of WBCs were
investigated separately, and it was found that one month of whey protein supplementation
with 6.6 g day had no effect on hematological parameter changes after resistance exercise
(Eslami et al., 2010).

Disadvantages of protein supplementation

Although many studies have theoretically demonstrated the benefits of protein supplementa-
tion on recovery of muscle function and performance, there appears to be insufficient exper-
imental data showing measurable reductions in muscle damage and enhanced recovery of
muscle function (Pasiakos, Lieberman, & McLellan, 2014).
A daily increment of 0.1 g protein · kg−1 was associated with an increased risk for microal-
buminuria, which is a predictor of renal and cardiovascular disease, in a study of a 50- to
75-year-old general population (Hoogeveen et al., 1998).
The analysis of the relationship between low-carbohydrate–high-protein diets, which are
often used for weight loss (Buchholz & Schoeller, 2004), and acid-base balance, kidney stone
risk, and calcium and bone metabolism found that the consumption of such diets for 6 weeks
led to a marked acid load for the kidneys, increased risk for stone formation, decreased esti-
mated calcium balance, and thereby increased risk for bone loss (Reddy et al., 2002).
An increase in protein intake significantly increased urinary calcium in men, even though
they were given 500 mg calcium daily (Anand & Linkswiler, 1974).
An increase of 34 g/day of animal protein in the diet significantly increased urinary calcium
(23%) and oxalate (24%), which corresponded to a marked increase in the overall relative
probability of forming stones (250%; Robertson et al., 1979).
Although high-protein diets are widely practiced for weight reduction, such diets are not
sustainable long term.
The general notion that protein-restricted diets decrease the risk of developing kidney
disease is not supported by scientific literature (Pecoits-Filho, 2007). However, preliminary
clinical and epidemiological studies have suggested a positive correlation among relatively
high-protein diets and major risk factors for chronic kidney disease, such as hypertension,
diabetes, obesity, and metabolic syndrome.
It was suggested that up to 80% of breast, bowel, and prostate cancers show strong positive
associations with meat consumption. However, the type, amount, processing, cooking, and
dose responses of meat or protein responsible for increasing the risk of cancer are uncertain
(Bingham, 1999; Norat & Riboli, 2001). In a study by Chow et al. (1994), it was found that
high protein intake could lead to increased risk of renal cell cancer.
Hence, consumption of protein derived from both natural sources and supplements could
lead to increased risk of various types of cancer.
Amino acids may contribute to insulin resistance (Patti et al., 1998). The data found in
the study on myotube cells supported the hypothesis that amino acids act as novel signaling
elements in insulin target tissues by acting as specific positive signals for maintenance of pro-
tein stores while inhibiting other actions of insulin at multiple levels. The prolonged action of
amino acids can thus lead to the development of insulin resistance and further to the devel-
opment of type 2 diabetes.
 JOURNAL OF DIETARY SUPPLEMENTS 369

The effect of high-protein diets on coronary blood flow has been studied, and it was found
that individuals following a high-protein diet showed a worsening of independent risk factors
in addition to progression of coronary artery disease (CAD) (Fleming & Boyd, 2000). It was
suggested that high-protein diets may precipitate progression of CAD through increased lipid
deposition and inflammatory and coagulation pathways.
Protein supplements have also been found to lead to increased incidence of acne vul-
garis in young adult users (Pontes et al., 2013). This could be because whey protein,
especially whey protein concentrate, contains intact milk hormones, which can cause
acne.
Although it has been found that high-protein diets can lead to weight loss, possibly due
to the higher energy required by the body for the assimilation of proteins (Buchholz &
Schoeller, 2004), excess intake of protein above the recommended dietary allowance may lead
to obesity, especially if the person lives a sedentary lifestyle, as the protein will get broken
down to release energy, intermediately stored as glycogen, and further stored in the body as
fat.
Intake of impure protein or protein contaminated with harmful additives can be life threat-
ening. A few cases have occurred in the recent past that have either lead to death or seriously
injured people, making the safety concerns regarding supplemental amino acids a serious
issue (Maher, 1994).
The purported health benefits of protein supplementation have led to overuse by both
adults and adolescents (Bell et al., 2004). Men and younger exercisers were found to focus on
supplements associated with performance enhancement and muscle building as compared to
other health-promoting products (El Khoury & Antoine-Jonville, 2012).
A high amount of protein supplementation is not recommended, because it restricts health-
ful foods that provide essential nutrients and does not provide the variety of foods needed to
adequately meet nutritional needs. Individuals who follow diets based solely on acquisition
of required daily allowance of protein from supplements are at risk for compromised vitamin
and mineral intake, as well as potential cardiac, renal, bone, and liver abnormalities overall
(St. Jeor et al., 2001).

Conclusion
It is widely believed that intake of protein can lead to better and faster gain of muscle, especially
among bodybuilders. Not many studies have found correlation between increased protein
intake and better performance at the gym or in sports.
Although the pros and cons of protein supplementation is a widely debated topic, not many
studies have been conducted regarding the same. The few studies that exist either provide
insufficient evidence or have not employed proper conditions for the conduct of the tests, as
many of the studies have small sample numbers and lack of dietary control.
However, it should be considered that protein supplements are processed materials and
often do not contain other essential nutrients required for the sustenance of a healthy lifestyle.
It is suggested that the required protein intake should be obtained from natural food sources,
and protein supplementation should be resorted to only if sufficient protein is not available in
the normal diet.

Declaration of interest
The authors declare no conflicts of interest. The authors alone are responsible for the content and writing
of the article.
370 J. R. K. SAMAL AND I. R. SAMAL

About the authors

Jay Rabindra Kumar Samal is currently a final year Bachelor of Technology student at Department of
Biotechnology, Manipal Institute of Technology, Manipal, India. His research interests include microflu-
idics, cell patterning and tissue regeneration. He has worked in various medical and research laborato-
ries during summer internships across multiple countries.
Indira R. Samal, MSc, is currently working as Professor of Biochemistry at Punjab Institute of Medical
Sciences, Punjab, India. She has obtained degrees of MBBS and MSc (Medical Biochemistry). She has
over 20 years of teaching and research experience. She is interested in research in metabolic diseases.

ORCID
Jay Rabindra Kumar Samal http://orcid.org/0000-0003-0764-8259

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