Quick Guide to Recommending a Protein Powder

Amy Smith, as part of her Green Oncology series

Amy  is a graduate of the College of Pharmacy at the University of Saskatchewan.  After completing a hospital residency program with the Regina Qu’Appelle Health Region, Amy began working with the Saskatchewan Cancer Agency in Saskatoon as a pediatric oncology pharmacist.  She is now attending the U of T post-baccalaureate PharmD program. During her time away from work, Amy enjoys traveling, volunteering and participating in a various athletics including powerlifting and running. Amy is a member of CAPhO's Communication Committee.

 

I lead somewhat of a double life.  By day – studious PostbaccPharmD student.  By night – iron lugging nationally ranked power lifter.  A bit of an odd combo as the two worlds appear so different but there are rare moments when they overlap.  As such, I have developed both a scientific and practical understanding of protein powders. 

The Issue:

As a result of cancer treatments and side effects, oncology patients often face decreased caloric intake.  Patients may seek calorically dense foods to maximize calories consumed while minimizing the quantity.  Patients may ask your opinion on protein powders or supplements leaving you feeling like a deer in headlights.  Recommending a protein powder can be overwhelming but the process can be simplified. 

The Solution:

There are two points to consider when making a recommendation: protein source and formulation. 

1)     Protein Source

Protein powders can be made from various protein sources; however, I will only touch on four as they are the most common and will serve as an appropriate option for the majority of your patients.  While whey and casein (or a blend of these two sources) are most common, patients with diet restrictions (e.g. vegetarian, lactose intolerance) may prefer an egg or soya based protein powder.  However, soya based products in patients with hormone sensitive cancers should be avoided. For more information to guide your recommendation, see below.  

Protein Powder- Source of Protein*

 

Whey

Casein

Egg

Soya

Quality**

1.00

1.00

1.00

1.00

Speed of Digestion

Fast

Slow

Slow

Fast

Mixable

Good

Poor

Poor

Good

Palatable

Good

Chalky

Thick texture

Gritty

Dietary Considerations

Reduced lactose content

(C/I true dairy allergy)

Lactose intolerant

Vegetarian

Lactose intolerant

Vegan

Comments

---

-May cause stomach upset

-Higher fat content vs other products

-Relatively low protein/serving

-May cause foul smelling gas

-Concerns of phytoestrogens

 

*This list is not all-inclusive.  Other protein sources are available. 

**The quality of a protein source is based on the amino acid requirements for humans and ability to digest it.  The Protein Digestibility Corrected Amino Acid Score (PDCAAS) is currently considered the gold standard in rating quality.  A PDCAAS rating of 1 is the highest and 0 is the lowest. 

2)     Formulation

Once settled on an appropriate source, consider a formulation.  Concentrates are the most common and economical formulations and contain varying amounts of fat and carbohydrates.  Some patients may experience stomach upset from a concentrate– certainly an unwanted side effect in oncology patients, therefore an isolate may be preferred.  An isolate, is a further purified concentrate that contains a higher amount of protein per serving.  Lastly, hydrolysates are a predigested protein formulation that allows for faster absorption when consumed post-workout and therefore occupying part of the athletic market.  However ,this plays no role if the goal is to simply increase overall calories (vs maximize muscle mass) as with oncology patients.  When maximizing calories is the goal, hydrolysate formulations are not worth the cost.

Protein Powder Formulations

 

Concentrates

Isolates

Hydrolysates

Protein Content

~80%

~90%

-Variable

-Pre-digested proteins

Cost

$

$$

$$$

Comments

-May cause bloating

-Decrease carbohydrates content

-Faster absorption

-May have bitter taste

Note: Many products will contain a “blend” of different protein sources or formulations.  No specific blend is beneficial over another.

 

The Bottom Line:

Recommending a protein powder for a patient can at first seem overwhelming but it doesn’t have to be.  Aside from patients with food intolerances/ preferences, an economical whey concentrate is likely a good first choice.   

References:

1) McDonald Lyle.  The Protein Book.A Complete Guide for the Athlete and Coach.  Salt Lake City, USA.  Lyle McDonald Publishing, 2007. 

2) Whey monograph. Natural Standards. Somerville, USA [accessed December 17, 2014] https://naturalmedicines.therapeuticresearch.com

3) Tipton, Kevin D., and Robert R. Wolfe. “Protein and Amino Acids for Athletes.” Journal of Sports Sciences 22, no. 1 (January 2004): 65–79.

4) Supplement-Goals Reference Guide. Examine.com, 2014.