May cause bone mineral loss, kidney damage — why ICMR dietary guidelines deter use of protein powders

The guidelines, issued last week, recommend getting proteins from the right diet. It comes at a time when India’s protein-based product market is growing.

Representational image | flickr

New Delhi: A key feature of last week’s dietary guidelines from the Indian Council of Medical Research-National of Nutrition (ICMR-NIN) is to avoid the usage of protein supplements for all population groups — including athletes.

NIN Director Dr. Hemalatha R. told ThePrint that the guidelines were in line with the latest science and growing evidence that everyone — including athletes — can get the recommended amount of protein through the right food items.

“Most athletes can get the recommended amount of protein through food alone, without the use of supplements. Protein powders are not required,” the guidelines, issued after 13 years, say, adding: “Moreover, prolonged intake of a large amount of protein is associated with potential dangers, such as bone mineral loss and kidney damage.”

This message has put the spotlight on the growing popularity of protein supplements in India. According to market estimates, India’s protein-based product market was Rs 33,000 crore in 2023 and is expected to grow annually at 15.8 percent to touch Rs 1.28 crore by 2032.

It’s for this reason that some nutrition specialists feel that the NIN guidelines are timely and will fill the void related to authoritative advisory on such supplements.

“The NIN guidelines are extremely useful because while it’s true that the awareness regarding food habits in Indians — such as the attention to protein and not only on a high carbohydrate-based diet — is a welcome change, the overreliance on supplements that we are seeing is largely market-driven and not necessarily backed by science,” Dr. Sujeet Ranjan, a Delhi-based public health nutrition specialist, told ThePrint.

In the Indian context, where dietary supplements, even herbal protein powders, are poorly regulated, the chances are that people taking them end up damaging their health and well-being instead of getting any benefit.

A first-of-its-kind analysis of 36 popular protein supplements sold in India, which came out last month, had shown that 70 percent were mislabeled, 14 percent of brands contained toxins and 8 percent had pesticide residue.

Shocking as it may be, that’s not all. Some such supplements available in the market and consumed by physically active people — with or without expert advice and supervision — could even contain banned substances like steroids, Dr. Suneeta Chandorkar, assistant professor in the department of food and nutrition at Maharaja Sayajirao University of Baroda, told ThePrint.

Protein, protein powders, and how much is too much 

Proteins are the primary structural and functional components of every living cell. About half of it is in the form of muscle and the rest are in bones, cartilage, and skin.

Proteins are complex molecules composed of 20 amino acids — nine of which are ‘essential’ and have to be obtained through diet because they are not made in the human body. The remaining are non-essential amino acids, which can be synthesized in the body to build proteins.

Protein requirements vary with age, physiological status, and stress, with growing infants and children, adolescents, pregnant women, and individuals during infections, illness, and physical stress needing more of it.

Animal foods like milk, meat, fish, and eggs, and plant foods such as pulses are rich sources of proteins. Animal proteins are of high quality since they are bioavailable and provide all the essential amino acids in the right proportions, while plant or vegetable proteins have a lower content of some of the essential amino acids.

NIN guidelines, however, say that a combination of cereals, millets, and pulses provides most of the amino acids.

According to Chandorkar, the NIN’s updated guidelines on Nutrient Requirements for Indians in 2020 advised a reduction in recommended dietary allowances (RDA) of protein from 1g/kg body weight to 0.83g/kg body weight which meets the requirements of 97.5 percent of the population. Meanwhile, the estimated average requirement was 0.66 percent, which meets the requirements for 50 percent of the population.

RDAs are the levels of intake of essential nutrients judged to be adequate to meet the known nutrient needs of practically all healthy persons. In contrast, EAR is the average daily level of intake of nutrients estimated to meet the requirements of 50 percent of healthy individuals.

While RDA is ideal, EAR is the bare minimum requirement.

“This was based on studies conducted on large population sets from India. This data was missing previously. Also, data on protein quality or biological value or protein availability from mixed vegetarian Indian diets was (by) then available and it was realised that the requirements need to be lowered,” she said.

Dr Rajeev Jayadevan, a Kerala-based medical researcher, said that a 60-kg adult requires 50-80 g protein/day depending on the level of physical activity.

Protein powders are made from eggs, dairy milk, whey, or plant sources such as soybeans, peas, and rice.

Some powders, marketed in packages as supplements, contain protein from multiple sources. According to NIN, some of these products may also contain added sugars, non-caloric sweeteners, and additives such as artificial flavouring, and are not advisable on a regular basis.

Even whey protein is rich in branched-chain amino acids (BCAAs), the agency says. Significantly, recent evidence suggests that BCAAs may increase the risk of certain non-communicable diseases.

The guidelines also emphasise that adequate energy from carbohydrates and fat is essential for the dietary protein to be utilised for synthesis and other body functions.

Many athletes consume very high amounts of protein, often as powders, but the NIN makes it clear that even their requirements are not as high as commonly perceived.

“In fact, research findings indicate that dietary protein supplementation is associated with only a small increase in muscle strength and size during prolonged resistance exercise training (RET) in healthy adults; and protein intake levels greater than 1.6g/kg/day do not contribute any further to RET-induced gains in muscle mass,” the guidelines note.

They also caution that prolonged intake of large amounts of protein powders or consumption of high protein concentrate has been associated with potential dangers, such as bone mineral loss and kidney damage.

Nabanita Saha, chief clinical dietician with Manipal Hospital in Bengaluru, welcomed the advisory, especially given the implicit health pitfalls associated with inordinate protein supplement intake, such as kidney damage, digestive effects, and imbalanced nutrient intake.

“A well-rounded diet that includes different protein sources— such as legumes, nuts, dairy, eggs, meat, and fish — can fulfil the protein requirements for all age groups.  Whole food gives not only protein but also essential vitamins, minerals, and fibres, which are frequently lacking in supplements,” she said.

Saha also said that there is a tendency — especially among youngsters — to follow fitness trends without complete knowledge.

“Educating them on the significance of a balanced and nutritious diet and the pitfalls of over-reliance on supplements is pivotal for promoting long-term health and well-being,” she said.

Jayadevan pointed out that in many cases, youngsters start taking protein and other dietary supplements based on advice given by gym trainers or their peers with no expertise in nutrition.

“In many cases, this advice is based on vested interest rather than science,” he said.

Where the nuances may be needed

But while the majority of the population does not need protein supplements, it doesn’t mean nobody needs them.

Jayadevan said that while the guidelines cover the basics, they don’t necessarily address each nuance. Other experts, too, agreed.

According to Vivekanand Jha, executive director of The George Institute for Global Health India in Delhi, there could be specific situations and population groups where protein supplements may be beneficial — even necessary.

These include older adults who experience sarcopenia (loss of muscle mass and strength), people with increased protein needs such as those recovering from surgery, injury, or malnutrition, those on dialysis, and those who have undergone bariatric surgery, among others.

“Some athletes and individuals engaged in intense physical training may also need it,” he said, cautioning that these supplements should be taken only under medical supervision.

Jayadevan, too, said that when it comes to turning to supplements, the role of a qualified dietitian who can assess individual nutritional needs is important.

“The gym owner or trainer is often not a trained dietitian, and should not be the sole source of advice about supplements,” he said.