Latest news with #LindaShiue
San Francisco Chronicle
18-05-2025
- Health
- San Francisco Chronicle
Bodybuilders love this supplement. Should older adults take it too?
Creatine, once thought of as strictly for bodybuilders and gym enthusiasts, may benefit a much broader swath of the population, especially older adults. Creatine is produced naturally in the body and increasingly becoming mainstream as a supplement. Some doctors are warming to the idea of recommending low daily doses of creatine to older patients looking to preserve muscle strength. Creatine is a compound that is produced in small amounts in the liver and kidneys, and is found in red meat and fish. When metabolized, creatine helps make ATP (adenosine triphosphate), a main energy source in cells. Many athletes take creatine for its 'energy-granting' benefits, particularly for short, explosive movements like HIIT (high-intensity interval training) and sprints. Studies show that when paired with resistance training, creatine supplements can increase muscle strength and endurance, prevent or reduce injury, promote muscle recovery and increase lean body mass. 'That's a good thing,' said Dr. Michael Fredericson, a Stanford sports medicine specialist who recommends people of all ages take a low dose of creatine, between three to five grams a day. More recently, studies have found it may also help prevent sarcopenia — muscle loss that starts around age 30, worsens with age, and can increase risk of falls among older adults. One 2015 meta-analysis found that 357 elderly adults with an average age of 64 who did 12 weeks of resistance training and supplemented their diet with creatine saw greater gains in muscle mass, strength and function. A 2014 meta-analysis similarly found that 405 elderly adults with an average age of 64 saw greater gains in muscle mass and upper body strength with creatine supplementation during resistance training compared to training alone. 'In the same way it can help boost muscle-building for people trying to get bulky, it's thought it can prevent sarcopenia in older adults who are not trying to bulk up,' said Dr. Linda Shiue, an internal medicine physician and director of culinary and lifestyle medicine at Kaiser Permanente in San Francisco. Fredericson, who himself takes three grams of creatine each day, said he 'really recommends it for people once you get past 50, definitely past 60, because you're starting to lose muscle mass.' 'Creatine supplementation, along with resistance training, is safe, simple to do and it's one of the best things you can do in terms of maintaining your muscle mass,' he said. More recent research is emerging that suggests creatine may also benefit cognitive function, including processing and short-term memory after sleep deprivation, Parkinson's and dementia. But those findings are considered preliminary and not definitive enough to make recommendations to patients to take it for these reasons, experts said. Shiue, a longtime primary care physician who generally does not recommend a lot of supplements to her patients, said she is considering recommending a small dose to her elderly patients and parents for the muscle-preserving potential, since many older adults have a hard time consuming enough protein to preserve muscle mass. 'I'm not a big supplement recommender,' she said. 'I find that people want to take a lot more supplements and I usually pare them down. But this is one I'm going to think about a little bit more because of its safety profile and because studies have been done in humans, and the benefit to harm ratio seems really very good.' While creatine is considered safe, some side effects may include weight gain and stomach upset. Creatine is found in meat and fish, but it's hard to get enough from diet alone, especially since people should be careful about eating too much meat, Fredericson said. And vegetarians don't get it through diet because plant products do not contain creatine. 'If you're a vegetarian athlete, that might be the subset that could really use it, besides the elderly,' Shiue said. If you're considering creatine supplements, experts say to look for a formulation called creatine monohydrate, read the label to make sure there aren't additives you're not looking for, and look for third-party verification by NSF or USP. These groups conduct safety testing for dietary supplements. Scientists previously thought that people with kidney disease should not take creatine, but those concerns have more recently been disproven. Still, experts say if you have a history of kidney problems, talk to your doctor first before starting creatine supplements.
San Francisco Chronicle
11-05-2025
- Health
- San Francisco Chronicle
Everyone is suddenly worried about protein. And there's one group that really should be
Across social media and even in more academic circles, protein is a hot topic at the moment: who needs it, how much they need and how best to consume it. The message from the gym bros and hot girls on TikTok is that most people need more protein, and their social media feeds are full of recipes, promotions and diet hacks to pump the macronutrient into every meal and snack. Nutrition experts, though, say the protein movement is missing some key concepts — notably, that most Americans already are getting plenty of it. In fact, the one demographic group that may be protein-deficient and actually in need of some resources is often not part of the conversation on social media: older adults. 'I think the focus on protein is exaggerated for most people,' said Dr. Linda Shiue, director of culinary and lifestyle medicine at Kaiser in San Francisco. 'Except for the elderly, who I really do think are protein deficient, most people are actually fiber deficient because they're not getting enough plant foods.' Danica Cowan, a registered dietician at UCSF, said she believes the recent interest in protein seems connected to the larger conversation about longevity and living long and healthy lives. 'Everyone and their mother is talking about longevity, and protein is critical for healthy aging,' Cowan said. What is protein? Protein is one of three macronutrients — the other two are carbohydrates and fats — that humans need large amounts of to operate all body functions. The body uses protein for many processes, including muscle growth and repair, which is what most people think of. But it also supports everything from the immune system to bone health, and it makes hormones that play a critical role in metabolism. 'Protein is used both at the cellular level and at the tiniest level in many different ways,' Shiue said. 'It's used to build and repair lean tissues, and that includes our muscles, which is what everyone's obsessed with. 'But the heart is a muscle, too,' she said. 'And protein is also important for skeletal health and other connective tissue. And our hair, skin and nails, that's protein, too.' People's protein needs change as they age, and also vary, sometimes dramatically, from person to person. Children need protein to help them grow and young adults might focus on it for weight loss or muscle development. 'I tell people: All foods are on a spectrum, that spectrum is different for everyone, and it changes over time,' said Cowan. Older adults need protein to help them maintain muscle and bone health, which is critical for staying active and healthy in later life. But they also may struggle more than any other demographic group to get enough protein in their diet. How much is enough? Protein may be key for human health and a trendy topic, but there's not actually a lot of research that says how much of it people should get. And the recommendations often are complicated for the average person to figure out for themselves. For example, the current national recommended daily allowance for protein is 0.8 grams per kilogram of bodyweight, which works out to about 54 grams. But Americans don't usually use grams, so it's not a familiar unit when thinking about food, and very few people will know their weight in kilograms. Plus, that recommendation is outdated, many nutrition experts said. But the science to update that number is lacking. Last year, a group of nutrition experts evaluated the daily protein recommendations and found that evidence was 'insufficient and inconclusive' to determine the needs across populations. So they left the old recommendations in place. 'People looking into health and aging are a little worried that the recommended daily allowance isn't enough,' said Christopher Gardner, a Stanford professor who has studied dietary needs for more than 30 years. But he noted that most Americans already consume more than the current recommendations — the average person gets about 90 grams a day. Rather than telling people how many grams of protein they need to eat, many nutrition experts advise people to make protein about a quarter to a third of their total food intake. The easiest way to do that is the 'plate method': That's where half of the plate is vegetables, a quarter is carbohydrates like rice or pasta, and a quarter protein. 'If you're eating roughly those proportions, the macronutrients take care of themselves,' Cowan said. It's possible to get too much protein, though usually that just means that the body will convert it to fat, which can be counterproductive to people who are trying to lose weight on protein-heavy diets. Excessive protein also can be a problem for people with chronic kidney disease. Protein sources Meat is the most obvious protein source, though most nutrition experts recommend people limit the beef and pork they consume because of the saturated fat content. Fish is preferable, and after that, poultry. Other animal-based sources of protein are yogurt, milk and cheese, and some of those are comparable to meat in terms of protein content. A cup of Greek yogurt has about the same amount of protein as a serving of beef. But plant-based sources can round out a diet; indeed, it's possible to get enough protein on a totally vegan diet. In particular, legumes — which includes beans, peas, lentils and peanuts — are excellent sources of protein. Legumes and other plant-based proteins are a staple of many diets around the world, but Americans have never quite embraced them. 'Think of Asian cultures eating tofu, Indian culture eating all kinds of lentil dishes, Mediterranean cultures have hummus, Latin American dishes, so many are bean-based,' said Gardner. 'In the U.S. it's paltry amounts of intake because they're all afraid they're going to fart,' he said. 'But if older people are worried about protein — stop obsessing and try to get more legumes in your diet.' Needs of older adults Unless they're eating only cookies and crackers, most Americans will get enough protein without paying attention to their diet, said Gardner. 'If you're getting a reasonable variety of food you're probably fine,' he said. But seniors may be the exception simply because they aren't consuming enough food overall, and because human bodies are less efficient at using protein as they age. Many older adults struggle with loss of appetite due to a number of factors, including illness, depression or being sedentary. If they're in assisted living where their meals are prepared for them, the food may not be tasty or appealing. Older adults who don't get enough protein may be at risk of falling and breaking bones, or losing muscle mass that helps them in other daily living tasks like cooking, bathing or cleaning. Cowan said this is one area where older adults and gym bros may have some overlap, in that both could benefit from supplemental sources of protein like powders. Most people should focus on getting protein from foods that they prepare at home or are minimally processed, she said. Very few people need to consume protein supplements, but for older adults who are really struggling to eat enough, it could help. 'For them, I'm OK with starting a protein supplement. I always like to use whole foods first, but I'd rather have them on a supplement than nothing at all,' she said. Cowan added that for most people, the first step to making sure they're getting enough protein is to just take a look at their diet. 'Emphasizing and paying attention to your sources of protein to make sure you're getting enough is a good idea if you're over 65,' Cowan said. 'A lot of older individuals tend to not prioritize protein, definitely older women in particular.' 'There's even a title — 'tea and toast seniors,'' she said. 'Those are the people who should think about protein the most. The gym bros probably don't need more protein, but the frail 70-year-old does.'
